No consensus on physicians' preferences on vascular access management after kidney transplantation: Results of a multi-national survey
| Autor: | Esther D. Wilschut, Koen E.A. van der Bogt, Friedo W. Dekker, Bram M. Voorzaat, Cynthia J. Janmaat, Joris I. Rotmans |
|---|---|
| Přispěvatelé: | Nephrology |
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Consensus medicine.medical_treatment Clinical Decision-Making 030232 urology & nephrology Vascular access Arteriovenous fistula kidney transplantation 030204 cardiovascular system & hematology Ventricular Function Left Nephrologists 03 medical and health sciences 0302 clinical medicine Arteriovenous Shunt Surgical hemodialysis access Renal Dialysis Risk Factors Original Research Articles medicine Humans ligation Practice Patterns Physicians' Kidney transplantation Hemodialysis access Aged business.industry cardiovascular Stroke Volume medicine.disease Prognosis Surgery Multi national Nephrology Regional Blood Flow Health Care Surveys Hemodialysis business Ligation Blood Flow Velocity |
| Zdroj: | Journal of Vascular Access. SAGE Journal of Vascular Access The Journal of Vascular Access Journal of Vascular Access, 20(1), 52-59 journal of vascular access, 20(1), 52-59. Wichtig Publishing |
| ISSN: | 1129-7298 |
| Popis: | Objective: Arteriovenous fistulas for hemodialysis vascular access are a burden for the cardiovascular system. After successful kidney transplantation, prophylactic arteriovenous fistula ligation may improve cardiac outcomes; however, evidence is scarce. This survey investigates physicians’ preference for management of arteriovenous fistulas and identifies the factors associated with preference for either arteriovenous fistula ligation or maintenance. Materials and methods: A survey was sent to members of eight national and international Nephrology and Vascular Surgery societies. The survey comprised eight case vignettes of asymptomatic patients with a functioning arteriovenous fistula after kidney transplantation. Characteristics possibly associated with treatment preferences were arteriovenous fistula flow, left ventricular ejection fraction, and patient age. Respondents were asked to state preference to maintain or ligate the arteriovenous fistula. Linear mixed-effects models were used to investigate the association of treatment preference with case characteristics. Results: A total of 585 surveys were returned. A reduced left ventricular ejection fraction of 30% (beta 0.60, 95% confidence interval 0.55; 0.65) and a high flow of 2500 mL/min (beta 0.46, 95% confidence interval 0.41; 0.51) were associated with a higher preference for arteriovenous fistula ligation. Disagreement among respondents was considerable, as in four out of eight cases less than 70% of respondents agreed on the arteriovenous fistula management strategy. Conclusion: Although respondents recognize a reduced left ventricular ejection fraction and a high flow as the risk factors, the high disagreement on management preferences suggests that evidence is inconclusive to recommend arteriovenous fistula ligation or maintenance after kidney transplantation. More research is needed to determine optimal arteriovenous fistula management after successful kidney transplantation. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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