Tamara Jemcov

Morphologic and functional vessels characteristics assessed by ultrasonography for prediction of radiocephalic fistula maturation

Purpose Although native radiocephalic arteriovenous fistula (RCAVF) is the best vascular access for hemodialysis (HD), a major obstacle to increase its use is high frequency of fistulas that fail to mature. The aim of this study was to investigate and define cut-off values of morphologic and functional vessel parameters influencing successful RCAVF maturation using ultrasound. Methods A prospective, observational study was performed on 122 patients (66 men) who underwent primary RCAVF creation. Internal diameters of cephalic vein (CVd) and radial artery (ARd), venous distensibility (VD), resistance index (RI) and endothelial function by flow mediated dilatation (FMD) were determined by ultrasound examination before AVF placement. AVF maturation was observed by measuring blood flow (Qa) and CVd 0, 14 and 28 days after creation. Depending on the time when AVFs attained maturity (Qa ≥500 mL/min, CVd ≥5 mm), patients were divided into three groups: (i) successful maturation (after four weeks), (ii) prolonged maturation (within eight weeks) and (iii) failure to mature. Results Only 11% of patients failed to achieve a mature RCAVF. Successful AVF maturation occurred in 53% of patients and prolonged maturation in 36% of patients. ROC analysis defined the limits of variables relevant for RCAVF success (CVd >1.8 mm, ARd >1.6 mm, VD >0.4 mm). Female sex was associated with prolonged maturation (OR 0.35, 95% CI=0.17-0.72; P=0.005) having a significantly smaller ARd (1.83 vs. 2.01 mm, P=0.01) but better FMD (2981.5 vs. 2689.5, P=0.02) compared to men. Conclusions ARd ≤1.6 mm, CVd ≤1.8 mm and VD ≤0.4 mm are exact cut-off points, which best predict nonmaturation of RCAVF. Women need extended time for adequately matured AVF.

Optimal timing for vascular access creation

Many guidelines recommend that end-stage renal disease (ESRD) patients should have a permanent vascular access, preferably an autologous arteriovenous fistula (AVF), at the start of renal replacement therapy. Nevertheless, a large proportion of patients still start hemodialysis with a central venous catheter (CVC). On the other hand, there are increasing numbers of patients in whom an AVF has been created, but who never actually end up on dialysis, as well as a substantial number of patients in whom creation of a vascular access has been attempted unsuccessfully. To improve this situation, timely exploration to assess suitability for and creation of preemptive AVF should be promoted. Decision to construct an AVF should depend on the likelihood and rate of progression to ESRD. For this goal, some reliable prediction models are available. Also, the likelihood that such an attempt will result in a successful outcome should be taken into account, but suitable validated models to accurately make such estimates are lacking. Next to patient-specific factors, some local conditions such as easy access to a vascular surgeon should also be incorporated in the decision-making process between the nephrology team and the patient.

Erratum to: Vascular access registry of Serbia: a 4-year experience

Nasta, Jelacic Rosa, Kostic Mirjana, Kovacevic Miodrag, Lazarevic Tatjana, Markovic Rodoljub, Micunovic Vesna, Milenkovic Olgica, Milenkovic Radomir, Milenkovic Srboljub, Milicevic Biserka, Milicevic Olivera, Nikolic Zora, Obrenovic Slavica, Orescanin Mira, Pavlovic Stevan, Pesic Snezana, Petkovic Dobrila, Pilipovic Dragana, Prokopovic Miomir, Radovanovic Zoran, Rakic Nenad, Rangelov Vanja, Sefer Kornelija, Sibalic Simin Marija, Stefanovic Nikola, Stojanovic Dragoslav, Stojanovic Stanojevic Marina, Tirmenstajn Jankovic Biserka, Vasic Jovanovic Vesna, Vasilic Kokotovic Olivera, Vojinovic Goran, Vuckovic Dragana, Vukelic Vesna, Vukic Jasmina, Zagorac Nikola, Zec Nenad. Erratum to: Int Urol Nephrol DOI 10.1007/s11255‐016‐1378‐9