NDT Advance Access published online on July 13, 2004
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh363
© 2004 by European Renal Association - European Dialysis and Transplant Association
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 Division of Nephrology, Department of Internal Medicine, Ann Arbor, Michigan, USA; Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, Michigan, USA; University Renal Research and Education Association, Ann Arbor, Michigan, USA
* To whom correspondence should be addressed. E-mail: rsaran{at}umich.edu.
Background. Optimal waiting time before first use of vascular access is not known. Methods. Two practices--first cannulation time for fistulae and grafts, and blood flow rate--were examined as potential predictors of vascular access failure in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Access failure (defined as time to first failure or first salvage intervention) was modelled using Cox regression. Results. Among 309 haemodialysis facilities, 2730 grafts and 2154 fistulae were studied. For grafts, first cannulation typically occurred within 2-4 weeks at 62% of US, 61% of European and 42% of Japanese facilities. For fistulae, first cannulation occurred <2 months after placement in 36% of US, 79% of European and 98% of Japanese facilities. Overall, the relative risk (RR) of graft failure in Europe was lower compared with the USA (RR = 0.69, P = 0.04). The RR of graft failure (reference group = first cannulation at 2-3 weeks) was 0.84 with first cannulation at <2 weeks (P = 0.11), 0.94 with first cannulation at 3-4 weeks (P = 0.48) and 0.93 with first cannulation at >4 weeks (P = 0.48). The RR of fistula failure was 0.72 with first cannulation at <4 weeks (P = 0.08), 0.91 at 2-3 months (P = 0.43) and 0.87 at >3 months (P = 0.31) (reference group = first cannulation at 1-2 months). Facility median blood flow rate was not a significant predictor of access failure. Conclusions. Earlier cannulation of a newly placed vascular access at the haemodialysis facility level was not associated with increased risk of vascular access failure. Potential for confounding due to selection bias cannot be excluded, implying the importance of clinical judgement in determining time to first use of vascular access.
Accepted May 19, 2004
Original Article
Timing of first cannulation and vascular access failure in haemodialysis: an analysis of practice patterns at dialysis facilities in the DOPPS
2 University Renal Research and Education Association, Ann Arbor, Michigan, USA
3 Department of Blood Purification and Internal Medicine, Kidney Center, Tokyo Women's Medical University, Tokyo, Japan
4 Center of Blood Purification Therapy, Wakayama Medical University, Wakayama, Japan
5 Nephrology Department, Lapeyronie University Hospital, Montpellier, France
6 Government Relations, Amgen Inc., Washington, DC, USA
7 Nephrology Service, Hospital General Vall d’Hebron, Barcelona, Spain
8 Institute of Medical Science, Tokai University School of Medicine, Kanagawa, Japan
9 Division of Nephrology, Department of Internal Medicine, Ann Arbor, Michigan, USA; Division of Nephrology, Department of Veterans Affairs Medical Center, Ann Arbor, Michigan, USA
Abstract 
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  R. N. Foley and R. M. Hakim Why Is the Mortality of Dialysis Patients in the United States Much Higher than the Rest of the World? J. Am. Soc. Nephrol., July 1, 2009; 20(7): 1432 - 1435. [Full Text] [PDF]
|
|
|
|
 |
|
 H. A. Chakkera, G. M. Chertow, A. M. O'Hare, W. J. Amend Jr., and T. A. Gonwa Regional Variation in Kidney Transplant Outcomes: Trends Over Time Clin. J. Am. Soc. Nephrol., January 1, 2009; 4(1): 152 - 159. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. A. Desai, R. Bolus, A. Nissenson, S. Bolus, M. D. Solomon, O. Khawar, M. Gitlin, J. Talley, and B. M. R. Spiegel Identifying Best Practices in Dialysis Care: Results of Cognitive Interviews and a National Survey of Dialysis Providers Clin. J. Am. Soc. Nephrol., July 1, 2008; 3(4): 1066 - 1076. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. E. Lok Fistula First Initiative: Advantages and Pitfalls Clin. J. Am. Soc. Nephrol., September 1, 2007; 2(5): 1043 - 1053. [Full Text] [PDF]
|
|
|
|
|
|
C. E. Lok, M. Allon, L. Moist, M. J. Oliver, H. Shah, and D. Zimmerman Risk Equation Determining Unsuccessful Cannulation Events and Failure to Maturation in Arteriovenous Fistulas (REDUCE FTM I) J. Am. Soc. Nephrol., November 1, 2006; 17(11): 3204 - 3212. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. C. Mendelssohn, J. Ethier, S. J. Elder, R. Saran, F. K. Port, and R. L. Pisoni Haemodialysis vascular access problems in Canada: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS II) Nephrol. Dial. Transplant., March 1, 2006; 21(3): 721 - 728. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Jindal, C. T. Chan, C. Deziel, D. Hirsch, S. D. Soroka, M. Tonelli, and B. F. Culleton CHAPTER 4: Vascular Access J. Am. Soc. Nephrol., March 1, 2006; 17(3_suppl_1): S16 - S23. [Full Text] [PDF]
|
|
|
|
|
|
C. J. Diskin and T. J. Stokes Vascular access cannulation and the end of religion: is it time or our own human variables that determine success? Nephrol. Dial. Transplant., September 1, 2005; 20(9): 2010 - 2011. [Full Text] [PDF]
|
|
|
|
|
|
G. Brunori, P. Ravani, S. Mandolfo, E. Imbasciati, F. Malberti, and G. Cancarini Fistula maturation: doesn't time matter at all? Nephrol. Dial. Transplant., April 1, 2005; 20(4): 684 - 687. [Full Text] [PDF]
|
|
|
|
|
|
R. Saran, R. L. Pisoni, and E. W. Young Timing of first cannulation of arteriovenous fistula: are we waiting too long? Nephrol. Dial. Transplant., April 1, 2005; 20(4): 688 - 690. [Full Text] [PDF]
|
|