TITLE: Outcomes of patients commencing peritoneal dialysis with and without back-up arteriovenous fistulas.

BACKGROUND: Transitions from peritoneal dialysis (PD) to haemodialysis (HD) are often unpredictable and central venous catheters (CVCs) are frequently required. Early studies found few back-up arteriovenous fistulas (bAVFs) were ever used. The PD population's characteristics have changed over time which may have altered the likelihood of bAVFs being used. This study aimed to report use of, and outcomes associated with, bAVFs in a contemporary cohort of peritoneal dialysis patients.

METHOD: A single-centre, retrospective study of PD patients commencing dialysis between 2006-2016, stratified according to presence/absence of bAVF.

RESULTS: One hundred seventy-six patients were included-82 with bAVF, 94 without bAVF-of whom 156 transitioned off PD. Transitions were to HD (49%), transplantation (23%), death (15%) and renal-recovery (1%). 51% of bAVFs were successfully used and 82% of bAVFs were patent when required. Median time from creation to bAVF use was 2.5 years. More patients with a bAVF transitioned to HD (62 vs 38%, p < 0.005). However, CVC requirement at the time of transition to HD was much less common in the bAVF group (18 vs 83%, p < 0.0001), such that the overall risk of requiring a CVC was significantly lower in the bAVF group (11 vs 31%, p < 0.005). Rates of returning to PD amongst patients who transitioned to HD with a CVC or an AVF were similar (19 vs 26%, p = 0.16).

CONCLUSIONS: In this cohort of PD patients, utilisation of back-up arteriovenous fistulas was higher than previously reported, and presence of a back-up arteriovenous fistula was associated with a lower rate of future CVC use.

SOURCE: Haralabopoulos E, Cosgrave MM, Mount PF, et al. Outcomes of patients commencing peritoneal dialysis with and without back-up arteriovenous fistulas[J]. J Nephrol, 2021, 34(1):89-95. DOI: 10.1007/s40620-020-00834-w. 

背景:从腹膜透析(PD)到血液透析(HD)的过渡通常是不可预测的，经常需要中心静脉置管(CVCs)。早期研究发现很少使用备用动静脉内瘘(bAVF)。PD人群的特征随着时间的推移而改变，这可能改变了使用bAVF的可能性。这项研究的目的是报告在当代腹膜透析患者队列中使用bAVF以及与其相关的结果。

方法：对2006-2016年间开始透析的PD患者进行单中心回顾性研究，根据有无bAVF进行分层。

结果：共纳入176例患者，其中82例合并备用动静脉内瘘，94例未合并备用动静脉内瘘，其中156例退出腹膜透析。转变为血液透析(49%)、移植(23%)、死亡(15%)和肾脏恢复(1%)。51%的bAVF使用成功，82%的bAVF在需要时仍可用。从建立到使用BAVF的中位时间为2.5年。有备用动静脉内瘘的患者更多地转为HD(62 vs 38%，p<0.005)。然而，在向HD过渡时，bAVF组需要中心静脉置管的情况要少得多(18 vs 83%，p<0.0001)，因此需要中心静脉置管的总体风险在bAVF组显著降低(11vs31%，p<0.005)。在使用CVC或AVF过渡到HD的患者中，返回PD的比率相似(19vs26%，p=0.16)。

结论：在这组PD患者中，备用动静脉内瘘的使用率高于以前的报道，并且备用动静脉内瘘的存在与CVC的未来使用率较低相关。

启发：备用动静脉内瘘可以降低未来转HD时CVC的使用率，但它的存在仍存在一定的争议，特别是对心脏的影响。