Arteriovenous Fistula Maturation Failure in a Large Cohort of Hemodialysis Patients in the Netherlands

Vascular Surger

Kidney function and symptom development over time in elderly patients with advanced chronic kidney disease: results of the EQUAL cohort study

Background. Initiation of renal replacement therapy often results from a combination of kidney function deterioration and symptoms related to chronic kidney disease (CKD) progression. We investigated the association between kidney function decline and symptom development in patients with advanced CKD.Methods. In the European Quality study on treatment in advanced CKD (EQUAL study), a European prospective cohort study, patients with advanced CKD aged >= 65 years and a kidney function that dropped <20 mL/min/1.73 m(2) were followed for 1 year. Linear mixed-effects models were used to assess the association between kidney function decline and symptom development. The sum score for symptom number ranged from 0 to 33 and for overall symptom severity from 0 to 165, using the Dialysis Symptom Index.Results. At least one kidney function estimate with symptom number or overall symptom severity was available for 1109 and 1019 patients, respectively. The mean (95% confidence interval) annual kidney function decline was 1.70 (1.32; 2.08) mL/min/1.73 m(2). The mean overall increase in symptom number and severity was 0.73 (0.28; 1.19) and 2.93 (1.34; 4.52) per year, respectively. A cross-sectional association between the level of kidney function and symptoms was lacking. Furthermore, kidney function at cohort entry was not associated with symptom development. However, each mL/min/1.73 m(2) of annual kidney function decline was associated with an extra annual increase of 0.23 (0.07; 0.39) in the number of symptoms and 0.87 (0.35; 1.40) in overall symptom severity.Conclusions. A faster kidney function decline was associated with a steeper increase in both symptom number and severity. Considering the modest association, our results seem to suggest that repeated thorough assessment of symptom development during outpatient clinic visits, in addition to the monitoring of kidney function decline, is important for clinical decision-making.Clinical epidemiolog

When to start dialysis?: Clinical and methodological issues involved

In this thesis we showed the clinical impact of several methodological issues that should be taken into account when studying chronic kidney disease progression and in order to find an answer to the question when to start dialysis. From a methodological point of view, the observations from this thesis provide several recommendations for future research with regard to studying associations of risk factors with CKD progression: the use of an inception cohort of incident patients, and using linear mixed effects models for analyses. Ultimately, patients with kidney failure could be subjected to dialysis. The optimal timing for dialysis initiation is unclear. Ideally, a randomized trial with all possible starting moments would be performed. However, this seems to be unfeasible due to the high patient number needed in each treatment arm. We have to rely on observational data, where methodological issues such as lead-time and immortal time bias arise. In this thesis, we showed the clinical impact of lead-time bias and how both types of bias were avoided by emulating a randomized trial using observational data in a pilot study. The methodology and recommendations provided in the thesis will be highly useful to find a more definitive answer in future research. </p

When to start dialysis?: Clinical and methodological issues involved

In this thesis we showed the clinical impact of several methodological issues that should be taken into account when studying chronic kidney disease progression and in order to find an answer to the question when to start dialysis. From a methodological point of view, the observations from this thesis provide several recommendations for future research with regard to studying associations of risk factors with CKD progression: the use of an inception cohort of incident patients, and using linear mixed effects models for analyses. Ultimately, patients with kidney failure could be subjected to dialysis. The optimal timing for dialysis initiation is unclear. Ideally, a randomized trial with all possible starting moments would be performed. However, this seems to be unfeasible due to the high patient number needed in each treatment arm. We have to rely on observational data, where methodological issues such as lead-time and immortal time bias arise. In this thesis, we showed the clinical impact of lead-time bias and how both types of bias were avoided by emulating a randomized trial using observational data in a pilot study. The methodology and recommendations provided in the thesis will be highly useful to find a more definitive answer in future research. Chipsoft BVLUMC / Geneeskund

Equivalentie van het EKO-keurmerk : vergelijkende studie naar Europese biologische pluslabels

Een vergelijkende studie naar Europese biologische pluslabels. De onderwerpen en aanvullende eisen van Biogarantie, Bioland, Naturland en Biosuisse zijn naast elkaar geplaatst en vergeleken met de EU normen en specifieke Nederlandse interpretatie tot nu toe

Patency outcomes of arteriovenous fistulas and grafts for hemodialysis access: a trade-off between non-maturation and long-term complications

INTRODUCTION: Arteriovenous fistulas (AVFs) for hemodialysis (HD) are often associated with better outcomes than arteriovenous grafts (AVG). We aimed to investigate vascular access (VA) outcomes and assessed if AVF non-maturation outweighs long-term complications of AVGs.METHODS: In this multicenter retrospective cohort-study in the Netherlands, one- and three-year primary, primary assisted, secondary and functional patency were calculated and the incidence of adverse events and procedures was assessed. Functional patency of RCAVFs, upper arm AVFs and AVGs was compared using Cox analyses.RESULTS: 1041 patients who received their first VA were included of which 863 successfully matured. These patients were analyzed with a median follow-up of 25 months. The one-year functional patency was 67 ± 2.0% for RCAVFs, 83 ± 2.0% for upper arm AVFs, and 85 ± 3.5% for AVGs, respectively. Three-year functional patency was 62 ± 2.0% for RCAVFs, 74 ± 2.0% for upper arm AVFs, and 69 ± 5% for AVGs, respectively. AVGs required more procedures per year (3.3/year) of functional patency when compared to upper arm AVFs (1.8/year).CONCLUSION: The functional patency of AVFs and AVGs is comparable, although AVGs required more interventions to maintain usability for hemodialysis. The choice of VA is a trade-off between short-term advantages, favoring AVGs and long-term advantages, favoring AVFs. Which VA is most appropriate depends on the patient’s prognosis and preferences.Nephrolog

Pitfalls of linear regression for estimating slopes over time and how to avoid them by using linear mixed-effects models

Clinical epidemiolog

Decline of kidney function during the pre-dialysis period in chronic kidney disease patients: a systematic review and meta-analysis

Diabetes mellitus: pathophysiological changes and therap

No consensus on physicians' preferences on vascular access management after kidney transplantation: Results of a multi-national survey

Vascular Surger