Arteriovenous fistula thrombosis is associated with increased all-cause and cardiovascular mortality in haemodialysis patients from the AURORA trial
| Autor: | Sergei Malikov, Luc Frimat, Patrick Rossignol, Sophie Girerd, Nicolas Girerd, Alan G. Jardine, Faiez Zannad, Bengt Fellström, Nicla Settembre, Roland E. Schmieder, Hallvard Holdaas |
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| Přispěvatelé: | Service de Néphrologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre d'investigation clinique plurithématique Pierre Drouin [Nancy] (CIC-P), Centre d'investigation clinique [Nancy] (CIC), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), Défaillance Cardiovasculaire Aiguë et Chronique (DCAC), Université de Lorraine (UL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Cardiovascular and Renal Clinical Trialists [Vandoeuvre-les-Nancy] (INI-CRCT), Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu [Nancy], French-Clinical Research Infrastructure Network - F-CRIN [Paris] (Cardiovascular & Renal Clinical Trialists - CRCT ), Medical Department, Rikshospitalet, University of Oslo, Renal Research Group, British Heart Foundation Glasgow Cardiovascular Research Centre (BHF GCRC), University of Glasgow-NHS Greater Glasgow and Clyde, Department of Nephrology and Hypertension, University Hospital Erlangen, Department of Nephrology, University Hospital, Uppsala, Service de Chirurgie Cardio-vasculaire [CHRU Nancy], P.R., N.G. and F.Z. are supported by a public grant overseen by the French National Research Agency (ANR) as part of the second Investissements d’Avenir’ programme (reference ANR-15-RHU-0004). The subjects have given their written informed consent. The study protocol has been approved by the research institute’s committee on human research., ANR-15-RHUS-0004,FIGHT-HF,Combattre l'insuffisance cardiaque(2015), BOZEC, Erwan, Combattre l'insuffisance cardiaque - - FIGHT-HF2015 - ANR-15-RHUS-0004 - RHUS - VALID, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lorraine (UL), University of Oslo (UiO) |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment 030232 urology & nephrology Arteriovenous fistula 030204 cardiovascular system & hematology survival arteriovenous graft 03 medical and health sciences 0302 clinical medicine [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system AURORA trial cardiovascular mortality Internal medicine Urologi och njurmedicin medicine Urology and Nephrology Rosuvastatin Cardiac and Cardiovascular Systems arteriovenous fistula vascular access complication Survival analysis Transplantation Kardiologi Proportional hazards model business.industry chronic haemodialysis Hazard ratio medicine.disease Thrombosis 3. Good health [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system Nephrology Cardiology Hemodialysis business Dialysis medicine.drug |
| Zdroj: | Clinical Kidney Journal Clinical Kidney Journal, Oxford University Press, 2020, 13 (1), pp.116-122. ⟨10.1093/ckj/sfz048⟩ Clinical Kidney Journal, 2020, 13 (1), pp.116-122. ⟨10.1093/ckj/sfz048⟩ |
| ISSN: | 2048-8505 2048-8513 |
| DOI: | 10.1093/ckj/sfz048⟩ |
| Popis: | 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 all-cause mortality, with a more pronounced association with early all-cause mortality {hazard ratio [HR] 90 days 1.47 [1.20–1.80], P 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. |
| Databáze: | OpenAIRE |
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