Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis
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)...
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Elsevier
2024-11-01
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| Series: | Kidney Medicine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059524001158 |
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| author | Hicham I. Cheikh Hassan Pauline Byrne Christie Harrod Donia George Karumathil Murali Jenny H.C. Chen Judy Mullan |
| author_facet | Hicham I. Cheikh Hassan Pauline Byrne Christie Harrod Donia George Karumathil Murali Jenny H.C. Chen Judy Mullan |
| author_sort | Hicham I. Cheikh Hassan |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-abf78fb76b154d2285e47de4b7f52109 |
| institution | Kabale University |
| issn | 2590-0595 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
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| series | Kidney Medicine |
| spelling | doaj-art-abf78fb76b154d2285e47de4b7f521092024-11-17T04:52:28ZengElsevierKidney Medicine2590-05952024-11-01611100904Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysisHicham I. Cheikh Hassan0Pauline Byrne1Christie Harrod2Donia George3Karumathil Murali4Jenny H.C. Chen5Judy Mullan6School of Medicine, Lebanese American University, Beirut, Lebanon; Department of Renal Medicine, Wollongong Hospital, Wollongong, NSW, Australia; Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia; Address for Correspondence: Hicham I. Cheikh Hassan, MD, Lebanese American University School of Medicine, Lebanese American University Medical Center- Rizk Hospital, May Zahhar Street, P. O. Box 11-3288, Ashrafieh, Beirut, Lebanon.Department of Renal Medicine, Wollongong Hospital, Wollongong, NSW, AustraliaDepartment of Renal Medicine, Wollongong Hospital, Wollongong, NSW, AustraliaDepartment of Renal Medicine, Wollongong Hospital, Wollongong, NSW, AustraliaDepartment of Renal Medicine, Wollongong Hospital, Wollongong, NSW, Australia; Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, AustraliaDepartment of Renal Medicine, Wollongong Hospital, Wollongong, NSW, Australia; Graduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, AustraliaGraduate School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, AustraliaRationale & 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.http://www.sciencedirect.com/science/article/pii/S2590059524001158Back-up arteriovenous fistuladialysis accessmeta-analysisperitoneal dialysissystematic review |
| spellingShingle | Hicham I. Cheikh Hassan Pauline Byrne Christie Harrod Donia George Karumathil Murali Jenny H.C. Chen Judy Mullan Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis Kidney Medicine Back-up arteriovenous fistula dialysis access meta-analysis peritoneal dialysis systematic review |
| title | Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis |
| title_full | Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis |
| title_fullStr | Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis |
| title_full_unstemmed | Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis |
| title_short | Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis |
| title_sort | back up arteriovenous fistulas in peritoneal dialysis patients a systematic review and meta analysis |
| topic | Back-up arteriovenous fistula dialysis access meta-analysis peritoneal dialysis systematic review |
| url | http://www.sciencedirect.com/science/article/pii/S2590059524001158 |
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