Incremental hemodialysis and vascular access complications: a 12-year experience in a hospital hemodialysis unit.

Autor: Fernández Lucas M; Nephrology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain. milagros.fernandez@salud.madrid.org.; Alcalá de Henares University, Madrid, Spain. milagros.fernandez@salud.madrid.org., Piris González M; Nephrology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain., Díaz Domínguez ME; Nephrology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain., Collado Alsina A; Nephrology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain., Rodríguez Mendiola NM; Nephrology Department, Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.
Jazyk: angličtina
Zdroj: Journal of nephrology [J Nephrol] 2024 Sep; Vol. 37 (7), pp. 1929-1937. Date of Electronic Publication: 2024 Jun 05.
DOI: 10.1007/s40620-024-01932-9
Abstrakt: Background: Incremental hemodialysis (HD) is considered a valid alternative for patients with residual kidney function. Evidence concerning its effect on vascular access is scarce. We present our 12-year experience of an incremental hemodialysis program with the aim of evaluating survival and complications of arteriovenous fistula in these patients compared to the thrice-weekly scheme.
Methods: From January 1st, 2006 to December 31st, 2017, 220 incident patients started hemodialysis, 132 (60%) of whom began hemodialysis with two sessions per week and 88 (40%) with three sessions per week. Demographic and clinical variables were assessed at the start of treatment. Data regarding arteriovenous fistula survival and complications were collected.
Results: Both groups had similar baseline sociodemographic and clinical characteristics. A total of 188 (85%) patients were dialyzed with an arteriovenous fistula during follow-up. Eighty-three patients had one or more fistula complications, with no differences between incremental and conventional groups (p = 0.55). Fistula survival rates showed no significant difference between the two groups, whether analyzed from the date of fistula creation (Log Rank p = 0.810) or from the date of initial fistula cannulation (Log Rank p = 0.695).
Conclusions: We found no differences in arteriovenous fistula survival or complication rate between patients who started HD with an incremental versus a conventional treatment scheme. Randomized controlled clinical trials may be warranted to achieve a higher degree of evidence.
(© 2024. The Author(s) under exclusive licence to Italian Society of Nephrology.)
Databáze: MEDLINE
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