La tunisie Medicale - 2021 ; Vol 99 ( n°05 ) : 575-581
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Arterio-venous fistula (AVF) is the first-choice vascular access for hemodialysis (HD). Hemodialysis catheter (KT) may be a temporary or permanent alternative.
Aim: To evaluate indications of KT and AVF and their predictive factors of complications.

It’s a retrospective multicentric study interesting KT and AVF in patients treated by hemodialysis, in the Kef Governorate in north-western Tunisia, during the period from 01/07/18 to 31/12/18.

We included 288 AVF and 148 KT that were created on 205 patients. The average age was 58.14 years, the sex ratio was 1.5. Hypertensive patients and diabetics represented respectively 83.9% and 27.3% of the population. Diabetic nephropathy was the most common (25.9%). For the KT, the main indication was the wait for AVF creation (68.9%). The overall incidence of immediate complications was 11.5%. Dysfunction was reported in 23.6% of cases with obesity and tunneled type of KT as contributing factors. KT infection was occuring in 39.2% of cases. It was promoted by prolonged duration of use and hemoglobin level < 8g/dl. The use of antiseptic lock reduced infections’ risk (p=0.011). For AVF, the most common complications were thrombosis (36.2%), aneurysm (29.9%) and stenosis (22.6%). Survival rate was 60% at 2000 days. The AVF impairing factors were diabetes (p=0.05), obesity (p=0.05), anterior AVF creation (p=0.011), AVF grafts (p=0.016), and anticoagulant therapy (p=0.0001). Antiplatelet therapy improved AVF patency (p=0.02).

Much remained to be done to reduce KT complications, creation of AVF on time and prevention of their complications.

Key - Words
  1. [1] Banerjee T, Kim SJ, Astor B, Shafi T, Coresh J, Powe NR. Vascular access type, inflammatory markers, and mortality in incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for End-Stage Renal Disease (CHOICE) Study. Am J Kidney Dis 2014; 64:954-61. [2] Do Hyoung K, Ji In P , Jung Pyo L, Yong-Lim K, Shin-Wook K, Chul Woo Y et al.The effects of vascularaccess types on the survival and quality of life and depression in the incident hemodialysis patients. Ren Fail 2020;42:30-9. [3] Firouraghi N, Jahromi SE, Sami A, Sharifian R. Duration of Vascular Access Usage and Patient Survival in the First Year of Hemodialysis. Iran J Kidney 2019;13:398-403. [4] Agarwal AK, Haddad NJ, Vachharajani TJ, Asif A. Innovations in vascular access for hemodialysis. Kidney Int 2019;95:1053-63 [5] Murea M, Geary RL, Davis RP, Moossavi S. Vascular access for hemodialysis: A perpetual challenge. Semin Dial 2019;32:527-34. [6] Raza H, Hashmi MN, Dianne V, Hamza M, Hejaili F, Sayyari AA. Vascular access outcome with a dedicated vascular team based approach. Saudi J Kidney Dis Transpl 2019;30:39-44. [7] Brescia MJ, Cimino JE, Appel K, Hurwich BJ. Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med 1966;275:1089-92. [8] Böhlke M, Uliano G, Barcellos FC. Hemodialysis catheter-related infection: prophylaxis, diagnosis and treatment. J Vasc Access 2015;16:347-55. [9] Lee T, Mokrzycki M, Moist L, Maya I, Vazquez M, Lok CE. Standardized definitions for hemodialysis vascular access. Semin Dial 2011;24:515-24. [10] 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;65:905-15. [11] KDOQI clinical practice guideline for vascular access. New York: National Kidney Foundation-Dialysis Outcomes Quality Initiative 2018. [12] Glaudet F, Jaïs JP, Moranne O, Lassalle M. Caractéristiques cliniques et indicateurs de prise en charge des patients en dialyse: rapport annuel du registre REIN. Agence of biomedecine 2016:191-235. [13] Ben Hamida F, M’hibik S, Karoui C, Abderrahim E, Kaaroud H, Beji S, et al. Indications, complications and cost of internal jugular catheters in hemodialysed patients: study of 533 cases. Tunis Med 2005;83:519-23. [14] Pisoni RL, Arrington CJ, Albert JM, Ethier J, Kimata N, Krishnan M, et al. Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis 2009;53:475-91. [15] Aran R, Li Y, Robinson B, Abbott KC, Agodoa LYC, Ayanian J, et al. United States renal data system: vascular access. Am J Kidney Dis. 2019;73:369-86. [16] Randriamanantsoa LN, Rajaonera TA, Ramanamidora DA, Ravalisoa ML, Andriamarotia HW, Rabenatoandro R. Les complications des cathéters veineux centraux d’hémodialyse dans les centres d’hémodialyse d’Antananarivo. Rev Anest Rea Med Urg 2011;3:1-5. [17] Lee T. Fistula first initiative: historical impact on vascular access practice patterns and influence on future vascular access care. Cardiovasc Eng Technol 2017;8:244-54. [18] Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg 2007;204:681-96. [19] Leou S, Garnier F, Testevuide P, Lumbroso C, Rigault S, Cordonnier C, et al. Infectious complications rate from hemodialysis catheters: experience from the French Polynesia Nephrol Ther 2013;9:137-42. [20] David N, Ian R, Elias A, Mohamad ALA, Vincent B, Sandra C, et al. DIALIN Network. 2018. [21] Chan MR. Hemodialysis central venous catheter dysfunction. Semin Dial 2008;21:516-21. [22] Bourquelot P. Abords vasculaires pour hémodialyse. Nephrol Ther 2009;5:239-48. [23] Smith GE, Gohil R, Chetter IC. Factors affecting the patency of arteriovenous fistulas for dialysis access. J Vasc Surg 2012;55:849-55. [24] Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DL. A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 2007;45:420-6. [25] Gibson KD, Gillen DL, Caps MT, Kohler TR, Sherrard DJ, Stehman Breen CO. Vascular access survival and incidence of revisions: a comparison of prosthetic grafts, simple autogenous fistulas, and venous transposition fistulas from the United States renal data system dialysis morbidity and mortality study. J Vasc Surg 2001;34:694-700. [26] Gheith OA, Kamal MM. Dialysis risk factors of vascular access failure in patients on hemodialysis. Iran J Kidney Dis 2008;2:201-7. [27] Kats M, Hawxby AM, Barker J, Allon M. Impact of obesity on arteriovenous fistula outcomes in dialysis patients. Kidney Int 2007;7:39-43. [28] Monroy Cuadros M, Yilmaz S, Salazar Bañ A, Doig C. Risk factors associated with patency loss of hemodialysis vascular access within 6 months. Clin J Am Soc Nephrol 2010;5:1787-92. [29] Wayne EJ, Brier ME, Dwyer AC. Association of maturation period blood pressure with dialysis access patency. Semin Dial 2013;26:90-6. [30] Kalantarinia K, Campbell A, Mourad S, Kauffnan J, Deaver K. 141: Timing of hemodialysis vascular access placement determines access outcomes. Am J Kidney Dis 2010;55:67. [31] Zouaghi MK, Lammouchi MA, Hassen M, Rais L, Smaoui W, Jebali H, et al. Determinants of patency of arteriovenous fistula in hemodialysis patients. Saudi J Kidney Dis Transpl 2018;29:615-22. [32] Asano M, Thumma J, Oguchi K, Pisoni RL, Akizawa T, Akiba T, et al. Vascular access care and treatment practices associated with outcomes of arteriovenous fistula: international comparisons from the dialysis outcomes and practice patterns study. Nephron Clin Pract 2013;124:23-30. [33] Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis. a randomized controlled trial. JAMA 2008;299:2164-71. [34] Saran R, Dykstra DM, Wolfe RA, Gillespie B, Held PJ, Young EW. Association between vascular access failure and the use of specific drugs: the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis 2002;40:1255-63. [35] United States Renal Data System: Annual Data Report 2018. Available at:
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