Ricardo Neto

Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort study

BackgroundAlthough several studies have demonstrated early survival advantages with peritoneal dialysis (PD) over hemodialysis (HD), the reason for the excess mortality observed among incident HD patients remains to be established, to our knowledge. This study explores the relationship between mortality and dialysis modality, focusing on the role of HD vascular access type at the time of dialysis initiation.MethodsA retrospective cohort study was performed among local adult chronic kidney disease patients who consecutively initiated PD and HD with a tunneled cuffed venous catheter (HD-TCC) or a functional arteriovenous fistula (HD-AVF) in our institution in the year 2008. A total of 152 patients were included in the final analysis (HD-AVF, n = 59; HD-TCC, n = 51; PD, n = 42). All cause and dialysis access-related morbidity/mortality were evaluated at one year. Univariate and multivariate analysis were used to compare the survival of PD patients with those who initiated HD with an AVF or with a TCC.ResultsCompared with PD patients, both HD-AVF and HD-TCC patients were more likely to be older (p<0.001) and to have a higher frequency of diabetes mellitus (p = 0.017) and cardiovascular disease (p = 0.020). Overall, HD-TCC patients were more likely to have clinical visits (p = 0.069), emergency room visits (p<0.001) and hospital admissions (p<0.001). At the end of follow-up, HD-TCC patients had a higher rate of dialysis access-related complications (1.53 vs. 0.93 vs. 0.64, per patient-year; p<0.001) and hospitalizations (0.47 vs. 0.07 vs. 0.14, per patient-year; p = 0.034) than HD-AVF and PD patients, respectively. The survival rates at one year were 96.6%, 74.5% and 97.6% for HD-AVF, HD-TCC and PD groups, respectively (p<0.001). In multivariate analysis, HD-TCC use at the time of dialysis initiation was the important factor associated with death (HR 16.128, 95%CI [1.431-181.778], p = 0.024).ConclusionOur results suggest that HD vascular access type at the time of renal replacement therapy initiation is an important modifier of the relationship between dialysis modality and survival among incident dialysis patients.

Percutaneous Treatment of Thrombosed Arteriovenous Fistulas: Clinical and Economic Implications

BACKGROUND AND OBJECTIVES Maintenance of previously thrombosed arteriovenous fistulas (AVFs) as functional vascular accesses can be highly expensive, with relevant financial implications for healthcare systems. The aim of our study was to evaluate the costs and health outcomes of vascular access care in hemodialysis patients with AVF thrombosis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A retrospective, controlled cohort study was performed among local hemodialysis patients with completely thrombosed AVFs between August 1, 2007, and July 1, 2008. Detailed clinical and demographic information was collected and a comprehensive measure of total vascular access costs was obtained. Costs are reported in 2009 U.S. dollars. RESULTS A total of 63 consecutive hemodialysis patients with thrombosed AVFs were identified--a cohort of 37 patients treated with percutaneous thrombectomy and a historic cohort of 25 patients with abandoned thrombosed AVFs. The mean cost of all vascular access care at 6 months was

Endovascular treatment of thrombosed dialysis fistulae: a cumulative cost analysis.

2479. Salvage of thrombosed AVFs led to a near two-fold reduction in access-related expenses, per patient-month at risk (

AB0424 Retrospective Evaluation of Mycophenolate Mofetil Infectious Side Effects on Lupus Nephritis Patients

375 versus

Rituximab for steroid-dependent nephrotic syndrome.

706; P = 0.048). The costs for access-related hospitalizations (

Cortical bone analysis in a predialysis population: a comparison with a dialysis population

393 versus

NEFROTOXICIDADE DOS ANTIVÍRICOS

91; P = 0.050), management of access dysfunction (

Antiviral drug-induced nephrotoxicity.

106 versus

SP095PREVALENCE OF LOW BONE DENSITY AND FRAGILITY FRACTURES IN PATIENTS WITH LUPUS NEPHRITIS

28; P = 0.005), and surgical interventions (

MP090ANCA ASSOCIATED GLOMERULONEPHRITIS: HISTOLOGICAL PREDICTORS OF RENAL OUTCOME

35 versus