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Buttonhole versus Stepladder Cannulation for Home Hemodialysis: A Multicenter, Randomized, Pilot Trial.

Shih-Han S Huang1, Jennifer MacRae2, Dana Ross3

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|January 20, 2019
PubMed
Summary
This summary is machine-generated.

This study found it was not feasible to randomize patients for home hemodialysis cannulation techniques. Patient preferences hindered recruitment for comparing buttonhole versus stepladder arteriovenous fistula cannulation.

Keywords:
ButtonholeCannulationCatheterizationCentral Venous CathetersDemographyHemodialysisHomeInformation Storage and RetrievalKidney Failure, ChronicPainPatient SelectionPilot ProjectsStep-Ladderarteriovenous fistuladiabetes mellitushemodialysis accessrandomized controlled trials

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Area of Science:

  • Nephrology
  • Vascular Access
  • Dialysis Techniques

Background:

  • Canadian guidelines identify arteriovenous fistula (AVF) cannulation technique as a research priority for home hemodialysis.
  • Potential differences in complications between cannulation methods require investigation.

Purpose of the Study:

  • To determine the feasibility of randomizing patients undergoing end-stage kidney disease (ESKD) training for home hemodialysis.
  • To compare buttonhole versus stepladder cannulation of the AVF.
  • To assess training time, needling pain, complications, and cost by cannulation technique.

Main Methods:

  • A randomized trial was designed across seven Canadian hospitals.
  • Patients training for home hemodialysis were assessed for eligibility and randomized to buttonhole or stepladder AVF cannulation.
  • Data collected included training time, pain scores, and complications over 12 months.

Main Results:

  • Recruitment occurred from November 2013 to November 2015, with 158 patients starting home hemodialysis training.
  • Only 14 of 50 eligible patients (28%) consented to participate, with technique preference being the main reason for refusal.
  • Buttonhole cannulation showed shorter training times but no reduction in pain or complications compared to stepladder.

Conclusions:

  • It was not feasible to conduct a randomized controlled trial comparing buttonhole and stepladder AVF cannulation in Canada.
  • Low patient enrollment and high refusal rates due to technique preference prevented meaningful conclusions.