Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis

IF 3.2 Q1 UROLOGY & NEPHROLOGY Kidney Medicine Pub Date : 2024-09-19 DOI:10.1016/j.xkme.2024.100904
Hicham I. Cheikh Hassan , Pauline Byrne , Christie Harrod , Donia George , Karumathil Murali , Jenny H.C. Chen , Judy Mullan
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Abstract

Rationale & Objective

Peritoneal dialysis (PD) is a dialysis modality limited by the potential need of transferring to hemodialysis. Optimal hemodialysis vascular access is an arteriovenous fistula. Back-up arteriovenous fistula (bAVF) is a strategy to prevent central venous catheter (CVC) insertion, but its use in the PD population has not been systematically reviewed.

Study Design

Systematic review and meta-analysis.

Setting & Study Populations

Studies including PD patients with a bAVF and the associated outcomes, including risk of hemodialysis transfer with a CVC and the proportion of bAVFs used.

Selection Criteria for Studies

Retrospective or prospective, observational studies, non-randomized or randomized controlled trials.

Data Extractions

Vascular access at time of hemodialysis transfer (bAVF vs CVC) for patients with and without a bAVF. The data on bAVF outcomes included bAVFs that stopped working, were never used, and the number of patients requiring hemodialysis.

Analytical Approach

Random-effects meta-analysis and meta-proportional analysis were conducted, with risk of bias within studies assessed using the Newcastle-Ottawa Scale.

Results

We screened 1,855 studies, 11 of which met the inclusion criteria, comprising 598 (62%) patients with a bAVF and 368 (38%) without. The proportion of bAVFs never used was 69% (95% confidence intervals [CI], 0.58-0.80; I2 = 86.2%). Meta-analysis of 8 studies found no difference in hemodialysis transfer between patients with a bAVF and those without (hazard ratio, 1.14; 95% CI, 0.86-1.51). However, the risk of hemodialysis transfer with a CVC was significantly lower in patients with a bAVF (hazard ratio, 0.43; 95% CI, 0.17-0.68).

Limitations

Substantial heterogeneity between the studies and large number of studies with poor quality.

Conclusions

bAVF was associated with a high rate of non-utilization but a lower risk of starting hemodialysis via a CVC. Future studies assessing long-term clinical outcomes may provide further insights into the role of bAVF creation in shaping dialysis unit policies.

Plain-Language Summary

Peritoneal dialysis (PD) is limited by hemodialysis transfer. The optimal vascular access in hemodialysis is the arteriovenous fistula, yet requirements for maturation often necessitate a central venous catheter (CVC) insertion in acute transfers from PD. A back-up arteriovenous fistula (bAVF) is a strategy used to avoid CVC use in such situations. However, no consensus is currently available on the best approach for bAVF in PD. By conducting a systematic review, we found that 69% of bAVFs were never used. Nevertheless, bAVFs reduced the risk of hemodialysis transfer with a CVC by almost 60%. The studies in the review were small in number and exhibited high heterogeneity, emphasizing that further research is needed to clarify the role and benefits of a bAVF in PD patients.
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腹膜透析患者的后备动静脉瘘:系统回顾和元分析
原理&amp; 目的腹膜透析(PD)是一种透析方式,但由于可能需要转为血液透析而受到限制。最佳的血液透析血管通路是动静脉内瘘。研究设计系统综述和荟萃分析。研究地点和范围;研究人群研究包括使用动静脉内瘘的腹膜透析患者及其相关结果,包括使用CVC进行血液透析转移的风险和使用动静脉内瘘的比例。研究的选择标准回顾性或前瞻性、观察性研究、非随机或随机对照试验。数据提取有无bAVF患者血液透析转运时的血管通路(bAVF与CVC)。分析方法采用随机效应荟萃分析和荟萃比例分析,使用纽卡斯尔-渥太华量表评估研究的偏倚风险。结果我们筛选了1855项研究,其中11项符合纳入标准,包括598名(62%)有bAVF的患者和368名(38%)无bAVF的患者。从未使用过 bAVF 的比例为 69%(95% 置信区间 [CI],0.58-0.80;I2 = 86.2%)。对 8 项研究进行的 Meta 分析发现,有 bAVF 和没有 bAVF 的患者在血液透析转运方面没有差异(危险比为 1.14;95% CI 为 0.86-1.51)。然而,bAVF患者使用CVC进行血液透析转移的风险明显较低(危险比为0.43;95% CI为0.17-0.68)。结论bAVF与较高的未使用率有关,但通过CVC开始血液透析的风险较低。未来对长期临床结果进行评估的研究可能会进一步揭示建立 bAVF 在制定透析室政策方面的作用.Plain-Language Summary腹膜透析(PD)受到血液透析转移的限制。血液透析的最佳血管通路是动静脉内瘘,但由于成熟度的要求,在急性腹膜透析转院时往往需要插入中心静脉导管(CVC)。备用动静脉内瘘 (bAVF) 是在这种情况下避免使用 CVC 的一种策略。然而,目前关于在腹膜透析患者中使用备用动静脉瘘的最佳方法尚未达成共识。通过系统回顾,我们发现 69% 的动静脉内瘘从未使用过。尽管如此,bAVF 仍将使用 CVC 进行血液透析的风险降低了近 60%。综述中的研究数量较少,异质性较高,因此需要进一步研究以明确 bAVF 在帕金森病患者中的作用和益处。
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来源期刊
Kidney Medicine
Kidney Medicine Medicine-Internal Medicine
CiteScore
4.80
自引率
5.10%
发文量
176
审稿时长
12 weeks
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