Prevalence and Risk Factors of Arterio-Venous Fistula Obstruction on Patient with Chronic Kidney Disease
Article Sidebar
Main Article Content
Abstract
Prevalence and Risk Factors of Arterio-Venous Fistula Obstruction on Patient with Chronic Kidney Disease
Ismail MT1, Hariawan H1, Wardhani Y2, Puspitasari M2, Artayasa IPA1, Ramadhan G1, Tarigan T1, Triatmaja R1
1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, 55284, Indonesia
2Department of Internal Medicine Faculty of Medicine Universitas Gadjah Mada-RSUP Dr. Sardjito Yogyakarta Indonesia
ABSTRACT
Aim:
AV fistula obstruction has become one of the main vascular access complications in patients undergoing haemodialysis. This complications have significant impacts on the morbidity and mortality of dialysis patients while also leading to higher medical costs. Clinical monitoring has been routinely used for early detection of AV fistula stenosis and obstruction, however screening with Doppler ultrasound is still not a routine recommendation. This study aims to know prevalence and risk factors of AV Fistula obstruction detected by Duplex ultrasound examination.
Methods:
This study was a hospital-based descriptive analytic study with cross sectional design conducted at the haemodialysis center of National General Hospital Dr. Sardjito, Yogyakarta, Indonesia. Patient demographic and clinical risk factor were recorded using direct interview. AV fistula obstruction were assessed using Duplex ultrasound by professional sonographer.
Results:
Seventy four (74) patients are using AV fistula as entry access for hemodialysis in RSUP dr. Sardjito. It is consist of 39 male (53%) and 35 Female (47%). The mean age of patients is 50 years old. Surveillance using Doppler ultrasound found 20 patients (27%) have stenotic AV Fistula. Smoking habits (OR 5.37, 95% CI, 1.760 - 16.431, p=0.002) and diabetes mellitus (OR 5.00, 95% CI, 1.631 – 15.503, p=0.004) increase risk for having stenotic AV fistula. Only 4 patient (20 %) of all 20 patient with stenotic AV fistula were symptomatic, and needed for further vascular intervention
Conclusion:
Prevalence of AV fistula obstruction detected by Doppler ultrasound was 27% of all AV fistula patient with only 5% had symptomatic AV fistula failure. Smoking habits and diabetes mellitus are important risk factor for AV fistula obstruction. Asymptomatic AV fistula obstruction often goes undetected by clinical monitoring that can increase of risk of symptomatic AV fistula obstruction in the future. The further study is needed to determine level recommendation of routine AV fistula surveillance with Doppler Ultrasound.
Key words: AV Fistula obstruction, CKD, Doppler ultrasound surveillance, Risk factors, Prevalence
Article Details
References
Arif, Asif, Carlos, Leon, Orozco-Vargas, Luis, Krishnamurthy, Gururaj, Kenneth Choi, Carlos, Mercado, Donna, Merril, Ian, Thomas, Loay, Salman, Shukhrat, Artikof, Jacques, Bourgoignie. 2007. Accuracy of Physical Examination in the Detection of Arteriovenous Fistula Stenosis. Miami : Clinical journal of the American Society of Nephrology Vol. 2; 1191-1194. doi.org/10.2215/CJN.02400607
Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan Republik Indonesia. 2018. Riset Kesehatan Dasar (Riskesdas) Tahun 2018. Jakarta : Kesehatan Kementerian Kesehatan Republik Indonesia.
Hill, Nathan R, Fatoba, Samuel T, Oke, Jason L, Hirst, Jennifer A, O’Callaghan, Christopher A., Lasserson, Daniel S., Hobbs, F.D. Richards. 2016. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. Journal PLoS One Edisi 11 Vol. 7; 1-18. https://doi.org/10.1371/journal.pone.0158765
Indonesian Renal Registry. 2016. 9th Report of Indonesian Renal Registry. https://www.indonesianrenalregistry.org/data/INDONESIAN%20RENAL%20REGISTRY%202016.pdf
Jha, Vivekanand, Garcia-Garcia, Guillermo, Iseki, Kunitoshi, Li Zuo, Naicker, Saraledevi, Plattner, Brett, Saran, Rajiv, Wang, Angela Yee-Moon, Yang, Chih-Wei. 2013. Chronic Kidney Disease: Global Dimension and Perspectives. USA: Lancet Vol. 382; 260–272. doi: 10.1016/S0140-6736(13)60687-X. Epub 2013 May 31.
Kazemzadeh, GH, Modaghegh, MHS, Ravari, H, Daliri M, Hoseini L, Nateghi M. 2012. Primary Patency Rate of Native AV Fistula: Long Term Follow Up. International Journal of Clinical and Experimental Medicine Vol.5(2); 173–178.. Epub 2012 Apr 6. PMID: 22567178; PMCID: PMC3342707.
KDOQI Advisory Board Members. 2006. NKF-KDOQI Clinical Practice Guidelines for Vascular Access. American Journal of Kidney Disease Supplement 1 Vol. 48; 1-322.
Koirala, Nischal, Anvari, Evamaria, dan McLennan, Gordon. 2016. Monitoring and Surveillance of Hemodialysis Access. Ohio: Semin Interventional Radiology Vol. 33; 25–33. doi: 10.1055/s-0036-1572548
MacRae, Jennifer M., Dipchand, Christine, Oliver, Matthew, Moist, Louise, Lok, Charmaine, Clark, Edward, Hiremath, Swapnil, Kappel, Joanne, Kiaii, Mercedeh, Luscombe, Rick, dan Miller, Lisa M. 2016. Arteriovenous Access Failure, Stenosis, and Thrombosis. Canada : Canadian Journal Kidney Health Disease Vol. 3; 1-11. doi: 10.1177/2054358116669126
Maldonado-Cárceles, Ana B., García-Medina, Jose, & Torres-Cantero, Alberto M. 2017. Performance of Physical Examination Versus Ultrasonography to Detect Stenosis in Haemodialysis Arteriovenous Fistula. The Journal of Vascular Access Vol. 18(1); 30–34. doi.org/10.5301/jva.5000616
Ocak, Gürbey, Rotmans, Joris I, Vossen, Carla Y, Rosendaal, Frits R, Krediet, Raymond T, Boeschoten, Elisabeth W, Dekker, Friedo W, dan Verduijn, Marion. 2013. Type of Arteriovenous Vascular Access and Association with Patency and Mortality. United Kingdom: BMC Nephrology Vol. 4; 1-8.
Pisoni RL, Zepel L, Port FK, Robinson BM. Trends in us vascular access use, patient preferences, and related practices: An update from the US DOPPS practice monitor with international comparisons. Am J Kidney Dis. 2015;65(6):905-915. doi:10.1053/j.ajkd.2014.12.014
Quencer, Keith Bertram dan Arici, Melih. 2015. Arteriovenous Fistulas and Their Characteristic Sites of Stenosis. USA: American Journal of Roentgenology Vol. 205(4); 726-734. 10.2214/AJR.15.14650
Quencer, Keith Bertram dan Oklu, Rahmi. 2017. Hemodialysis Access Thrombosis. Phoenix: Cardiovascular Diagnosis and Therapy Vol. 7(3); 299–S308. doi: 10.21037/cdt.2017.09.08
Ravani, P., Palmer, S. C., Oliver, M. J., Quinn, R. R., MacRae, J. M., Tai, D. J., Pannu, N. I., Thomas, C., Hemmelgarn, B. R., Craig, J. C., Manns, B., Tonelli, M., Strippoli, G. F., & James, M. T. (2013). Associations between hemodialysis access type and clinical outcomes: a systematic review. Journal of the American Society of Nephrology : JASN, 24(3), 465–473. https://doi.org/10.1681/ASN.2012070643
Ren, Chong, Chen, Jing, Wang, Yong, Huang, Bihong, Lu, Wenwen, Cao, Yanpei, Yang, Xiaoli. 2018. Application of Ultrasonography in Monitoring The Complications of Autologous Arteriovenous Fistula in Hemodialysis Patients. Shanghai : Medicine Vol. 97; 1-7. doi: 10.1097/MD.0000000000012994
Salman, Loay dan Beathard, Gerald. 2013. Interventional Nephrology: Physical Examination as a Tool for Surveillance for the Hemodialysis Arteriovenous Access. Journal American Society of Nephrology Vol.8 (7); 1220-1227. doi: 10.2215/CJN.00740113.
Schroeder, Emily B., Yang, Xiuhai, Thorp, Micah L., Arnold, Brent M., Tabano, David C., Petrik, Amanda F., Smith, David H., Platt, Robert W., Johnson, Eric S. 2017. Predicting 5-year risk of RRT in Stage 3 or 4 CKD: Development and External Validation. Miami : Clinical Journal American Society of Nephrology Vol. 12; 87-94. DOI: https://doi.org/10.2215/CJN.01290216
Smith, G. E., Gohil, R., & Chetter, I. C. (2012). Factors affecting the patency of arteriovenous fistulas for dialysis access. Journal of vascular surgery, 55(3), 849–855. https://doi.org/10.1016/j.jvs.2011.07.095
Stolic, Radojica. 2013. Most Important Chronic Complications of Arteriovenous Fistulas for Hemodialysis. Medical Principal Practice Vol. 22; 220-228. doi: 10.1159/000343669. Epub 2012 Nov 2.
Tjang YS and Sumadi GJ. (2018). Primary Patency Rate of Arteriovenous Fistula Created for Hemodialysis Patients: The Indonesian Experience. Journal of the Association for Vascular Access. 23(4):229-233
USRDS. Annual Data Report. Morbidity and Mortality in Patients With CKD. 2016. Washington: USRDS Coordinating Center.
Viecelli, Andrea K., Mori, Trevor A., Roy-Chaudhury, Prabir, Polkinghorne, Kevan R., Hawley, Carmel M., Johnson, David W., Pascoe, Elaine M., Irish, Ashley. B. 2017. The Pathogenesis of Hemodialysis Vascular Access Failure and Systemic Therapies for Its Prevention: Optimism Unfulfilled. Seminars in Dialysis Vol. 31(3); 244- 257.
Wetzig, G.A., Gough, I.R. and Furnival, C.M. (1985), ONE HUNDRED CASES OF ARTERIOVENOUS FISTULA FOR HAEMODIALYSIS ACCESS: THE EFFECT OF CIGARETTE SMOKING ON PATENCY. Australian and New Zealand Journal of Surgery, 55: 551-554. https://doi.org/10.1111/j.1445-2197.1985.tb00943.x
Wo, K., Morrison, B. J., & Harada, R. N. (2017). Developing Duplex Ultrasound Criteria for Diagnosis of Arteriovenous Fistula Stenosis. Annals of vascular surgery, 38, 99–104. https://doi.org/10.1016/j.avsg.2016.04.013
Yan, Y., Ye, D., Yang, L., Ye, W., Zhan, D., Zhang, L., Xiao, J., Zeng, Y., & Chen, Q. (2018). A meta-analysis of the association between diabetic patients and AVF failure in dialysis. Renal failure, 40(1), 379–383. https://doi.org/10.1080/0886022X.2018.1456464
Zamboli, Pasquale, Fiorini, Fulvio, D’Amelio, Alessandro, Fatuzzo, Pasquale, dan Granata, Antonio. 2014. Color Doppler Ultrasound and Arteriovenous Fistulas for Hemodialysis. Journal of Ultrasound Vol. 17(4); 253–263. doi: 10.1007/s40477-014-0113-6