NDLI: Thrombophilia and arteriovenous fistula survival in ESRD.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Salmela, Birgitta Hartman, Jari Peltonen, Seija Albäck, Anders Lassila, Riitta
Description	Country affiliation: Finland Author Affiliation: Salmela B ( Coagulation Disorders, Department of Hematology, HUSLAB Laboratory Services, Helsinki University Central Hospital, Helsinki, Finland.)
Abstract	BACKGROUND AND OBJECTIVES: The role of thrombophilia in failing arteriovenous fistula (AVF) among patients with ESRD undergoing hemodialysis is not established. This study aimed to assess whether AVF primary patency is associated with thrombophilia and coagulation abnormalities. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This observational study screened 219 patients between 2002 and 2004 for thrombophilia before AVF surgery. Thrombophilia included factor V Leiden and prothrombin G20210A mutations, protein C and antithrombin activities, and protein S. Coagulation abnormalities included high factor VIII:C, homocysteine, fibrinogen, and d-dimer levels; presence of antiphospholipid antibodies; and short thrombin time. We reviewed patient charts for comorbid conditions, AVF maturation and interventions, kidney transplantation, and patient survival (mean follow-up duration, 3.6 [range, 2.3-5.8] years). Primary patency from the AVF placement and functional primary patency from the first AVF cannulation were analyzed with Kaplan-Meier and Cox proportional hazards models. RESULTS: Thrombophilia was present in 9% of the patients, and coagulation abnormalities occurred in 77%. One-year primary patency was 68%; 46% of the AVF failures occurred before the initiation of hemodialysis. Female sex (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.7-4.1) and thrombophilia (HR, 2.2; 95% CI, 1.2-4.2) were independent risk factors for loss of primary patency. Thrombophilia mutations or low antithrombin level (HR, 3.8), female sex (HR, 2.5), and diabetes (HR, 1.9) were associated with shortened functional primary patency of AVF. CONCLUSIONS: Against the background of frequent coagulation abnormalities, thrombophilia and female sex predispose patients with ESRD to access failure, mostly due to thrombosis or stenosis.
File Format	HTM / HTML
ISSN	15559041
e-ISSN	1555905X
DOI	10.2215/CJN.03860412
Journal	Clinical Journal of the American Society of Nephrology
Issue Number	6
Volume Number	8
Language	English
Publisher	American Society of Nephrology
Publisher Date	2013-06-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Chi-square Distribution Kaplan-meier Estimate Therapy Research Support, Non-u.s. Gov't Diabetes Complications Blood Etiology Blood Coagulation Genetics Diagnosis Adverse Effects Arteriovenous Shunt, Surgical Complications Risk Factors Proportional Hazards Models Discipline Nephrology Genetic Predisposition To Disease Physiopathology Thrombophilia Phenotype Adolescent Sex Factors Blood Coagulation Tests Kidney Failure, Chronic Mutation Graft Occlusion, Vascular Renal Dialysis Dna Mutational Analysis Vascular Patency Observational Study
Content Type	Text
Resource Type	Article
Subject	Transplantation Critical Care and Intensive Care Medicine Nephrology Epidemiology

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Determinants of haemodialysis access survival.

Functional polymorphisms in matrix metalloproteinases-1, -3, -9 are associated with arteriovenous fistula patency in hemodialysis patients.

Outcomes of arteriovenous fistula creation after the Fistula First Initiative.

The influence of thrombophilic risk factors on vascular access survival in chronic dialysis patients in a retrospective evaluation.

Thigh grafts contribute significantly to patients' time on dialysis.

Natural history of upper limb arterio-venous fistulae for chronic hemodialysis.

Cumulative patency of contemporary fistulas versus grafts (2000-2010).

The longevity of arteriovenous graft for hemodialysis patients--externally supported or nonsupported.

Endovascular treatment of hemodialysis arteriovenous fistulas: is immediate post-interventional blood flow a predictor of patency.

Thrombophilia and arteriovenous fistula survival in ESRD.

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Determinants of haemodialysis access survival.

Functional polymorphisms in matrix metalloproteinases-1, -3, -9 are associated with arteriovenous fistula patency in hemodialysis patients.

Outcomes of arteriovenous fistula creation after the Fistula First Initiative.

The influence of thrombophilic risk factors on vascular access survival in chronic dialysis patients in a retrospective evaluation.

Thigh grafts contribute significantly to patients' time on dialysis.

Natural history of upper limb arterio-venous fistulae for chronic hemodialysis.

Cumulative patency of contemporary fistulas versus grafts (2000-2010).

The longevity of arteriovenous graft for hemodialysis patients--externally supported or nonsupported.

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