Premium
Does the extracorporeal blood flow affect survival of the arteriovenous vascular access?
Author(s) -
Ponce Pedro,
Marcelli Daniele,
Scholz Caecilia,
Wehmeyer Wolfgang,
Gonçalves Pedro,
Grassmann Aileen,
Brand Katharina,
Canaud Bernard
Publication year - 2015
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12240
Subject(s) - medicine , hazard ratio , hemodialysis , cardiology , proportional hazards model , confidence interval , dialysis , extracorporeal , blood flow , surgery , urology
Hemodiafiltration with high‐convective volumes is associated with improved patient survival, whereby practical realization is contingent on high extracorporeal blood flow ( Q b) and dialysis treatment time. However, Q b is restricted by vascular access ( VA ) quality and/or concerns that high Q b could damage the VA . Taking VA quality into consideration, one can investigate the relationship between Q b and VA survival. We analyzed data from 1039 patients treated by hemodiafiltration over a 21‐month period where access blood flow ( Q a) measurements were also available at baseline. VA failure was defined as a surgical intervention resulting in the generation of a new VA . Q a was included as a stratification variable within a C ox regression model. A second C ox proportional hazard model with a penalized spline was used to describe the association between Q b and VA survival. Compared with Q b in the 350–357 mL/min range, a significantly higher hazard ratio ( HR ) for VA failure was detected for fistula only, and then only for Q b < 312 mL/min ( HR : 2.361, 95% confidence interval [ CI ]: 1.251–4.453), Q b = 387–397 mL/min ( HR : 1.920, 95% CI : 1.007–3.660) and Q b >414 mL/min ( HR : 2.207, 95% CI : 1.101–4.424). Age, gender, diabetes, VA vintage, position of the VA , and arterial pressure were not significantly associated with outcome. The form of the penalized spline confirmed higher risk for VA failure for the lowest and the highest values of Q b. Taking Q a into consideration, no association was found between VA failure and Q b up to flows as high as approximately 390 mL/min.