Vascular access types in patients starting hemodialysis after failed kidney transplant: does close nephrology...

Area of Science:

• Nephrology
• Vascular Surgery
• Renal Replacement Therapy

Background:

• Native arteriovenous fistulae (AVFs) are the preferred vascular access (VA) for hemodialysis (HD), while central venous catheters (CVCs) are least suitable.
• Approximately 80% of patients initiate HD with CVCs, often due to late referral to nephrologists.
• This study examines VA types at HD initiation in renal transplant recipients with failed transplants to assess the impact of nephrologist referral timing.

Purpose of the Study:

• To evaluate the prevalence of different vascular access (VA) types at hemodialysis (HD) initiation among renal transplant recipients whose transplants failed.
• To determine if early referral to a nephrologist influences the choice of VA, specifically aiming for higher AVF utilization.

Main Methods:

• Retrospective analysis of renal transplant recipients with failed transplants between January 2002 and April 2013.
• Data collected included VA planning, renal replacement therapy (RRT) discussions, estimated glomerular filtration rate (eGFR), timing of VA referral, and VA type at dialysis initiation.
• Statistical analysis was performed to compare VA types at HD initiation.

Main Results:

• Of 83 patients, 66 started HD. Only 4/34 (11.3%) initiated HD with an AVF, while 30/34 (88.3%) used a CVC (p<0.0001).
• Significant proportions had eGFR <15 mL/min at last clinic visit (61%) and lacked documented RRT discussion (68%), VA referral (76%), or vein mapping (79%).
• These findings indicate poor vascular access planning despite potential for earlier intervention.

Conclusions:

• Early referral to a nephrologist alone may not be sufficient to improve vascular access (VA) care for patients with end-stage renal disease.
• The study highlights a significant gap in timely and appropriate vascular access planning, even in patients with previously transplanted kidneys.