THE DETERMINATION OF DURATION OF SURVIVAL OF PERMANENT VASCULAR ACCESS ESTABLISHED FOR HEMODIALYSIS IN PATIENTS WITH CHRONIC KIDNEY FAILURE AND AN INVESTIGATION OF THE FACTORS AFFECTING THOSE DURATIONS

Amaç: Kronik böbrek yetersizliği tanısıyla hemodiyaliz planlanan ve kalıcı damar yolu oluşturulan hastalarda, bu kalıcı damar yollarının (arteriovenöz fistül (AVF), arteriovenöz greft (AVG) ve kalıcı kateter) patenslerinin belirlenmesi ve bu Patensi etki eden faktörlerin tespit edilip bu sayede bundan sonra oluşturulacak olan kalıcı damar yolu patenslerinin uzatılmasına katkı sağlamaktır. Materyal ve Metod: Çalışmamıza KTÜ Nefroloji kliniğinde Kronik Böbrek Yetmezliği tanısıyla takip edilen, KTÜ Tıp Fakültesi Göğüs Kalp Damar Cerrahisi kliniği cerrahları tarafından kalıcı hemodiyaliz girişi oluşturulması amacıyla AVF, AVG ve kalıcı kateter uygulanan ve arşivinden dosyalarına ulaşılabilen 18 yaş ve üzeri, 420 hasta alındı. Hastaların biyokimyasal, hematolojik ve demografik verileri kaydedildi. Bu parametrelerin vasküler erişim yolu patensi üzerine etkisi analiz edildi. Bulgular: Çalışmamızda kalıcı damar yolu oluşturulan 420 KBY hastasının % 86’sında AVF, % 10,5’unda AVG, % 9,8’inda ise kalıcı kateter uygulandığı belirlenmiştir. Çalışmaya alınan hastalarda ortalama AVF patensi 34.73 ay, ortalama AVG patensi 27.59 ay, ortalama kalıcı kateter patensi ise 8.53 ay olarak belirlendi. Vasküler erişim yolu patensini yaş, vasküler erişim yolu oluşturulmadan önceki santral venöz kataterizasyon öyküsü, vasküler erişim yolunun ilk kullanım zamanı ve operasyon öncesi üst ekstremite arteriyel ve venöz dopler USG incelemesinin etkilediği saptandı. Sonuç: Kalıcı damar yolunun ömrünün uzatılmasında hastanın yaşı, santral venöz kateter öyküsü ve fistül ve greftin olgunlaşma sürecinin beklenmesi önem arz etmektedir. Hemodiyaliz için kalıcı damar yolu planlanan hastada santral venöz kateter uygulamasından kaçınılmalı ve kanüle edilmeden önce AVFAVG’in olgunlaşma süreci beklenmelidir.Aim: To determine survival of permanent vascular access routes (arteriovenous fistula [AVF], arteriovenous graft [AVG] and permanent catheter) in patients scheduled for hemodialysis with a diagnosis of chronic kidney disease (CKD) and in whom permanent vascular access is established, and to identify factors affecting those survival rates, thus contributing to prolongation of survival of subsequent permanent vascular access routes pathways. Materials and Methods: 420 patients under monitoring with a diagnosis of CKD at the KTU Nephrology Clinic receiving AVF, AVG or permanent catheter for the purpose of establishing permanent hemodialysis access by surgeons from the KTU Medical Faculty Thoracic and Cardiovascular Surgery Department aged 18 or over and whose files were available from the archives were included in the study. Patients’ biochemical, hematological and demographic data were recorded. The effect of these parameters on vascular access survival was then analyzed. Results: AVF was applied in 86% of the 420 CKD cases in this study, AVG in 10.5% and permanent catheter in 9.8%. Mean AVF patensi was 34.73 months, mean AVG survival 27.59 months and mean permanent catheter survival 8.53 months. Vascular access survival was affected by age, a history of central venous catheterization before establishment of vascular access, time of first use of vascular access and upper extremity arterial and venous Doppler USG examination before surgery. Conclusion: The patient’s age, history of central venous catheter use and waiting time for fistula and graft maturation are important in terms of prolonging survival of permanent vascular access routes. Central venous catheterization should be avoided in patients scheduled for permanent vascular access for hemodialysis, and it is important to wait for AVF-AVG maturation before cannulation

The Determinatıon of Duration of Survival of Permanent Vascular Access Established For Hemodialysis In Patients With Chronic Kidney Failure and An Investigation of The Factors Affecting Those Durations

Aim:To determine survival of permanent vascular access routes (arteriovenous fistula [AVF], arteriovenous graft [AVG] and permanent catheter) in patients scheduled for hemodialysis with a diagnosis of chronic kidney disease (CKD) and in whom permanent vascular access is established, and to identify factors affecting those survival rates, thus contributing to prolongation of survival of subsequent permanent vascular access routes pathways.Materials and Methods:420 patients under monitoring with a diagnosis of CKD at the KTU Nephrology Clinic receiving AVF, AVG or permanent catheter for the purpose of establishing permanent hemodialysis access by surgeons from the KTU Medical Faculty Thoracic and Cardiovascular Surgery Department aged 18 or over and whose files were available from the archives were included in the study. Patients’ biochemical, hematological and demographic data were recorded. The effect of these parameters on vascular access survival was then analyzed.Results:AVF was applied in 86% of the 420 CKD cases in this study, AVG in 10.5% and permanent catheter in 9.8%. Mean AVF patensi was 34.73 months, mean AVG survival 27.59 months and mean permanent catheter survival 8.53 months. Vascular access survival was affected by age, a history of central venous catheterization before establishment of vascular access, time of first use of vascular access and upper extremity arterial and venous Doppler USG examination before surgery.Conclusion:The patient’s age, history of central venous catheter use and waiting time for fistula and graft maturation are important in terms of prolonging survival of permanent vascular access routes. Central venous catheterization should be avoided in patients scheduled for permanent vascular access for hemodialysis, and it is important to wait for AVF-AVG maturation before cannulation

The prevalence of Fabry disease in a Turkish population with chronic kidney patients

Background and objectives: Fabry disease (FD) is an X-linked lysosomal storage disease with various clinical symptoms due to a deficiency of an enzyme called alpha-galactosidase A. The likelihood of nephropathy increases with age and the severity of the mutation in Fabry patients. Fabry disease is difficult to diagnose. The exact incidence and prevalence of Fabry disease are unknown due to its atypical or oligosymptomatic forms. Design, setting, participants, and measurements: GLA gene mutations were examined in patients over the age of 18 who were followed up on with a diagnosis of chronic kidney disease and who had or did not receive renal replacement therapy from October 2017 to December 2019. Results: A total of 18 sites in 8 locations around Turkey volunteered to participate in the study, including people aged 18 and older with stages 1–5 of chronic kidney disease (CKD) or getting renal replacement therapy. 1904 patients were screened in total. In 13 cases, a D313Y pseudo mutation in the GLA gene was discovered. GLA gene mutations were found and pathologically assessed in four of the tested cases. Conclusions: The range of clinical symptoms of Fabry disease, as well as the frequent delays in diagnosis, result in treatment being too late. We believe that screening chronic renal patients at high risk for Fabry disease is warranted