Arteriovenous fistula creation may slow estimated glomerular filtration rate trajectory

被引:34
作者
Golper, Thomas A. [1 ]
Hartle, Phillip Matthew [1 ]
Bian, Aihua [1 ]
机构
[1] Vanderbilt Univ, Med Ctr & Dialysis Clin Inc, Med Nephrol Vanderbilt Ctr Kidney Dis, 221 Kirkland Hall, Nashville, TN 37235 USA
关键词
arteriovenous fistula; chronic kidney disease; eGFR trajectory; HD access; hemodialysis; KIDNEY-FUNCTION DECLINE; ARTERIAL STIFFNESS; PROGRESSION; DISEASE; CKD;
D O I
10.1093/ndt/gfv082
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
Background. We practice the timely placement of an arteriovenous fistula (AVF) in patients facing chronic hemodialysis. We have anecdotally observed after AVF creation that there appears to be a slowing of the decline in kidney function as measured by the estimated glomerular filtration rate (eGFR). There are physiologically plausible explanations as to how an AVF might alter kidney function, but this clinical observation has been attributed to improved compliance and/or other practices. The present retrospective observational analysis was performed to assess the possibility that a successfully created AVF could be associated with the slowing of the eGFR trajectory. Methods. We identified 123 patients between 2005 and 2010 with at least two eGFR determinations for 2 years before and up to 2 years after AVF creation. Inclusion eligibility was that the fistula was maturing by the nephrologists' initial post-creation examination. Termination events were death, starting dialysis or transplantation. Each subject served as their own control for the pre- and post-AVF-creation eGFR measurements. Results. Subjects' median age was 68 years and 56% were diabetic. The rate of change of the eGFR for the 2 years prior to AVF creation was -5.9 mL/min/year (95% CI: -5.3, -6.5) and after AVF creation -0.5 mL/min/year (95% CI: -1.1, 0.1) (interaction (P < 0.001). Conclusions. A functioning AVF may be associated with a slowing of the eGFR decline. Agreeing to timely AVF creation selects patients in an otherwise typical population and other confounders have not yet been eliminated. To do so a thorough prospective observational study is indicated.
引用
收藏
页码:2014 / 2018
页数:5
相关论文
共 21 条
[1]   Rate of Kidney Function Decline Associates with Mortality [J].
Al-Aly, Ziyad ;
Zeringue, Angelique ;
Fu, John ;
Rauchman, Michael I. ;
McDonald, Jay R. ;
El-Achkar, Tarek M. ;
Balasubramanian, Sumitra ;
Nurutdinova, Diaria ;
Xian, Hong ;
Stroupe, Kevin ;
Abbott, Kevin C. ;
Eisen, Seth .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2010, 21 (11) :1961-1969
[2]   Vascular Access Creation before Hemodialysis Initiation and Use: A Population-Based Cohort Study [J].
Al-Jaishi, Ahmed A. ;
Lok, Charmaine E. ;
Garg, Amit X. ;
Zhang, Joyce C. ;
Moist, Louise M. .
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2015, 10 (03) :418-427
[3]  
[Anonymous], 1997, NKF DOQI CLIN PRACT, P22
[4]   RENAL FUNCTIONAL RESERVE IN HUMANS - EFFECT OF PROTEIN-INTAKE ON GLOMERULAR-FILTRATION RATE [J].
BOSCH, JP ;
SACCAGGI, A ;
LAUER, A ;
RONCO, C ;
BELLEDONNE, M ;
GLABMAN, S .
AMERICAN JOURNAL OF MEDICINE, 1983, 75 (06) :943-950
[5]   CHRONIC HEMODIALYSIS USING VENIPUNCTURE AND A SURGICALLY CREATED ARTERIOVENOUS FISTULA [J].
BRESCIA, MJ ;
CIMINO, JE ;
APPEL, K ;
HURWICH, BJ .
NEW ENGLAND JOURNAL OF MEDICINE, 1966, 275 (20) :1089-&
[6]   Decline in Estimated Glomerular Filtration Rate and Subsequent Risk of End-Stage Renal Disease and Mortality [J].
Coresh, Josef ;
Turin, Tanvir Chowdhury ;
Matsushita, Kunihiro ;
Sang, Yingying ;
Ballew, Shoshana H. ;
Appel, Lawrence J. ;
Arima, Hisatomi ;
Chadban, Steven J. ;
Cirillo, Massimo ;
Djurdjev, Ognjenka ;
Green, Jamie A. ;
Heine, Gunnar H. ;
Inker, Lesley A. ;
Irie, Fujiko ;
Ishani, Areef ;
Ix, Joachim H. ;
Kovesdy, Csaba P. ;
Marks, Angharad ;
Ohkubo, Takayoshi ;
Shalev, Varda ;
Shankar, Anoop ;
Wen, Chi Pang ;
de Jong, Paul E. ;
Iseki, Kunitoshi ;
Stengel, Benedicte ;
Gansevoort, Ron T. ;
Levey, Andrew S. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2014, 311 (24) :2518-2531
[7]   Kidney oxygenation during water diuresis and endothelial function in patients with type 2 diabetes and subjects at risk to develop diabetes [J].
Economides, PA ;
Caselli, A ;
Zuo, CS ;
Sparks, C ;
Khaodhiar, L ;
Katsilambros, N ;
Horton, ES ;
Veves, A .
METABOLISM-CLINICAL AND EXPERIMENTAL, 2004, 53 (02) :222-227
[8]   Arterial stiffness and plasma creatinine in untreated hypertensive patients [J].
Gosse, P ;
Safar, ME .
AMERICAN JOURNAL OF HYPERTENSION, 2005, 18 (09) :1140-1145
[9]   A model for a proportional treatment effect on disease progression [J].
Greene, T .
BIOMETRICS, 2001, 57 (02) :354-360
[10]  
Greene Tom, 1997, P887