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Arteriovenous fistu...
Arteriovenous fistula thrombosis is associated with increased all-cause and cardiovascular mortar in haemodialysis patients from the AURORA trial
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- Girerd, Sophie (author)
- Univ Hosp, Dept Nephrol, Nancy, France.;Lorraine Univ, Univ Hosp, Ctr Invest Clin Plurithemat, INSERM, Nancy, France.;F CRIN INI CRCT, Nancy, France.
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- Girerd, Nicolas (author)
- Lorraine Univ, Univ Hosp, Ctr Invest Clin Plurithemat, INSERM, Nancy, France.;F CRIN INI CRCT, Nancy, France.
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- Frimat, Luc (author)
- Univ Hosp, Dept Nephrol, Nancy, France.;F CRIN INI CRCT, Nancy, France.
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- Holdaas, Hallvard (author)
- Univ Oslo, Rikshosp, Med Dept, Oslo, Norway.
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- Jardine, Alan G. (author)
- Univ Glasgow, British Heart Fdn Cardiovasc Res Ctr, Inst Cardiovasc & Med Sci, Renal Res Grp, Glasgow, Lanark, Scotland.
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- Schmieder, Roland E. (author)
- Univ Hosp Erlangen, Dept Nephrol & Hypertens, Erlangen, Germany.
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- Fellström, Bengt, 1947- (author)
- Uppsala universitet,Njurmedicin
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- Settembre, Nicla (author)
- Univ Hosp, Dept Vasc Surg, Nancy, France.
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- Malikov, Sergei (author)
- Univ Hosp, Dept Vasc Surg, Nancy, France.
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- Rossignol, Patrick (author)
- Lorraine Univ, Univ Hosp, Ctr Invest Clin Plurithemat, INSERM, Nancy, France.;F CRIN INI CRCT, Nancy, France.
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- Zannad, Faiez (author)
- Lorraine Univ, Univ Hosp, Ctr Invest Clin Plurithemat, INSERM, Nancy, France.;F CRIN INI CRCT, Nancy, France.
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Univ Hosp, Dept Nephrol, Nancy, France;Lorraine Univ, Univ Hosp, Ctr Invest Clin Plurithemat, INSERM, Nancy, France.;F CRIN INI CRCT, Nancy, France. Lorraine Univ, Univ Hosp, Ctr Invest Clin Plurithemat, INSERM, Nancy, France.;F CRIN INI CRCT, Nancy, France. (creator_code:org_t)
- 2019-05-11
- 2020
- English.
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In: Clinical Kidney Journal. - : Oxford University Press (OUP). - 2048-8505 .- 2048-8513. ; 13:1, s. 116-122
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Abstract
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- Background. The impact of arteriovenous fistula (AVF) or graft (AVG) thrombosis on mortality has been sparsely studied. This study investigated the association between AVF/AVG thrombosis and all-cause and cardiovascular mortality.Methods. The data from 2439 patients with AVF or AVG undergoing maintenance haemodialysis (HD) included in the A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events trial (AURORA) were analysed using a time-dependent Cox model. The incidence of vascular access (VA) thrombosis was a pre-specified secondary outcome.Results. During follow-up, 278 AVF and 94 AVG thromboses were documented. VA was restored at 22 +/- 64 days after thrombosis (27 patients had no restoration with subsequent permanent central catheter). In multivariable survival analysis adjusted for potential confounders, the occurrence of AVF/AVG thrombosis was associated with increased early and late allcause mortality, with a more pronounced association with early all-cause mortality {hazard ratio [HR] < 90 days 2.70 [95% confidence interval (CI) 1.83-3.97], P < 0.001; HR > 90 days 1.47 [1.20-1.80], P < 0.001). In addition, the occurrence of AVF thrombosis was significantly associated with higher all-cause mortality, whether VA was restored within 7 days [HR 1.34 (95% CI 1.02-1.75), P = 0.036] or later than 7 days [HR 1.81 (95% CI 1.29-2.53), P = 0.001].Conclusions. AVF/AVG thrombosis should be considered as a major clinical event since it is strongly associated with increased mortality in patients on maintenance HD, especially in the first 90 days after the event and when access restoration occurs >7 days after thrombosis. Clinicians should pay particular attention to the timing of VA restoration and the management of these patients during this high-risk period. The potential benefit of targeting overall patient risk with more aggressive treatment after AVF/AVG restoration should be further explored.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Urologi och njurmedicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Urology and Nephrology (hsv//eng)
Keyword
- arteriovenous fistula
- arteriovenous graft
- cardiovascular mortality
- chronic haemodialysis
- survival
- vascular access complication
Publication and Content Type
- ref (subject category)
- art (subject category)
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Girerd, Sophie
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Girerd, Nicolas
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Frimat, Luc
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Holdaas, Hallvar ...
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Jardine, Alan G.
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Schmieder, Rolan ...
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Fellström, Bengt ...
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Settembre, Nicla
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Malikov, Sergei
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Rossignol, Patri ...
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Zannad, Faiez
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- MEDICAL AND HEALTH SCIENCES
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Clinical Kidney ...
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Uppsala University