Hemodialysis Vascular Access and Risk of Major Bleeding, Thrombosis, and Cardiovascular Events: A Cohort StudyPlain-Language Summary
Rationale & Objective: The risks of major bleeding, thrombosis, and cardiovascular events are elevated in patients receiving maintenance hemodialysis (HD). Our objective was to compare the risk of these outcomes in HD according to the permanent vascular access type. Study Design: Observation...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | Kidney Medicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590059522000693 |
| _version_ | 1818546900384612352 |
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| author | Nicholas S. Roetker Haifeng Guo Dena Rosen Ramey Ciaran J. McMullan G. Brandon Atkins James B. Wetmore |
| author_facet | Nicholas S. Roetker Haifeng Guo Dena Rosen Ramey Ciaran J. McMullan G. Brandon Atkins James B. Wetmore |
| author_sort | Nicholas S. Roetker |
| collection | DOAJ |
| description | Rationale & Objective: The risks of major bleeding, thrombosis, and cardiovascular events are elevated in patients receiving maintenance hemodialysis (HD). Our objective was to compare the risk of these outcomes in HD according to the permanent vascular access type. Study Design: Observational cohort study. Setting & Participants: Using data from the United States Renal Data System (2010-2015), we included patients with kidney failure who were greater than 18 years, had Medicare as the primary payer, were not using an oral anticoagulant, and were newly using an arteriovenous (AV) access for HD. Exposure: AV graft (AVG) or AV fistula (AVF). Outcomes: Major bleeding, venous thromboembolism, ischemic stroke, myocardial infarction, cardiovascular death, and critical limb ischemia. Analytical Approach: Comparing 17,763 AVG and 60,329 AVF users, we estimated the 3-year incidence rates and incidence rate ratios (IRRs) of each outcome using Poisson regression. IRRs were adjusted for sociodemographic and clinical covariates. Results: The use of an AVG, compared with that of an AVF, was associated with an increased risk of venous thromboembolism (10.8 vs 5.3 events per 100 person-years; adjusted IRR, 1.74; 95% CI, 1.63-1.85) but not with the risk of major bleeding (IRR, 1.04; 95% CI, 0.93-1.17). The use of an AVG was also potentially associated with a slightly increased risk of cardiovascular death (IRR, 1.09; 95% CI, 1.01-1.16). Limitations: This analysis focused on patients with a functioning AV access; adverse events that may occur during access maturation should also be considered when selecting a vascular access. Conclusions: The use of an AVG, relative to an AVF, in HD is associated with an increased risk of venous thromboembolism. Given recent guidelines emphasizing selection of the “right access” for the “right patient,” the results of this study should potentially be considered as one additional factor when selecting the optimal access for HD. |
| first_indexed | 2024-12-12T07:59:25Z |
| format | Article |
| id | doaj.art-6e213afa4896459984a432b4321391aa |
| institution | Directory Open Access Journal |
| issn | 2590-0595 |
| language | English |
| last_indexed | 2024-12-12T07:59:25Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney Medicine |
| spelling | doaj.art-6e213afa4896459984a432b4321391aa2022-12-22T00:32:11ZengElsevierKidney Medicine2590-05952022-06-0146100456Hemodialysis Vascular Access and Risk of Major Bleeding, Thrombosis, and Cardiovascular Events: A Cohort StudyPlain-Language SummaryNicholas S. Roetker0Haifeng Guo1Dena Rosen Ramey2Ciaran J. McMullan3G. Brandon Atkins4James B. Wetmore5Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota; Address for Correspondence: Nicholas S. Roetker, PhD, MS, Chronic Disease Research Group, Hennepin Healthcare Research Institute, 701 Park Ave, Suite S2.100, Minneapolis, MN 55415.Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MinnesotaMerck & Co, Inc, Kenilworth, New JerseyMerck & Co, Inc, Kenilworth, New JerseyMerck & Co, Inc, Kenilworth, New JerseyChronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota; Division of Nephrology, Hennepin County Medical Center and Department of Medicine, University of Minnesota, Minneapolis, MinnesotaRationale & Objective: The risks of major bleeding, thrombosis, and cardiovascular events are elevated in patients receiving maintenance hemodialysis (HD). Our objective was to compare the risk of these outcomes in HD according to the permanent vascular access type. Study Design: Observational cohort study. Setting & Participants: Using data from the United States Renal Data System (2010-2015), we included patients with kidney failure who were greater than 18 years, had Medicare as the primary payer, were not using an oral anticoagulant, and were newly using an arteriovenous (AV) access for HD. Exposure: AV graft (AVG) or AV fistula (AVF). Outcomes: Major bleeding, venous thromboembolism, ischemic stroke, myocardial infarction, cardiovascular death, and critical limb ischemia. Analytical Approach: Comparing 17,763 AVG and 60,329 AVF users, we estimated the 3-year incidence rates and incidence rate ratios (IRRs) of each outcome using Poisson regression. IRRs were adjusted for sociodemographic and clinical covariates. Results: The use of an AVG, compared with that of an AVF, was associated with an increased risk of venous thromboembolism (10.8 vs 5.3 events per 100 person-years; adjusted IRR, 1.74; 95% CI, 1.63-1.85) but not with the risk of major bleeding (IRR, 1.04; 95% CI, 0.93-1.17). The use of an AVG was also potentially associated with a slightly increased risk of cardiovascular death (IRR, 1.09; 95% CI, 1.01-1.16). Limitations: This analysis focused on patients with a functioning AV access; adverse events that may occur during access maturation should also be considered when selecting a vascular access. Conclusions: The use of an AVG, relative to an AVF, in HD is associated with an increased risk of venous thromboembolism. Given recent guidelines emphasizing selection of the “right access” for the “right patient,” the results of this study should potentially be considered as one additional factor when selecting the optimal access for HD.http://www.sciencedirect.com/science/article/pii/S2590059522000693Cardiovascular eventsmaintenance hemodialysismajor bleedingvascular accessvenous thromboembolism |
| spellingShingle | Nicholas S. Roetker Haifeng Guo Dena Rosen Ramey Ciaran J. McMullan G. Brandon Atkins James B. Wetmore Hemodialysis Vascular Access and Risk of Major Bleeding, Thrombosis, and Cardiovascular Events: A Cohort StudyPlain-Language Summary Kidney Medicine Cardiovascular events maintenance hemodialysis major bleeding vascular access venous thromboembolism |
| title | Hemodialysis Vascular Access and Risk of Major Bleeding, Thrombosis, and Cardiovascular Events: A Cohort StudyPlain-Language Summary |
| title_full | Hemodialysis Vascular Access and Risk of Major Bleeding, Thrombosis, and Cardiovascular Events: A Cohort StudyPlain-Language Summary |
| title_fullStr | Hemodialysis Vascular Access and Risk of Major Bleeding, Thrombosis, and Cardiovascular Events: A Cohort StudyPlain-Language Summary |
| title_full_unstemmed | Hemodialysis Vascular Access and Risk of Major Bleeding, Thrombosis, and Cardiovascular Events: A Cohort StudyPlain-Language Summary |
| title_short | Hemodialysis Vascular Access and Risk of Major Bleeding, Thrombosis, and Cardiovascular Events: A Cohort StudyPlain-Language Summary |
| title_sort | hemodialysis vascular access and risk of major bleeding thrombosis and cardiovascular events a cohort studyplain language summary |
| topic | Cardiovascular events maintenance hemodialysis major bleeding vascular access venous thromboembolism |
| url | http://www.sciencedirect.com/science/article/pii/S2590059522000693 |
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