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Kidney Week

Abstract: SA-PO357

Vascular Access Creation Decelerates Renal Function Decline and Its Determinant Factors

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 301 CKD: Risk Factors for Incidence and Progression

Authors

  • Yan, Ming-Tso, Cathay General Hospital, Taipei, Taiwan
  • Lin, Shih-Hua P., Tri-Service General Hospital, Neihu, Taiwan
Background

Vascular access (VA) creation before hemodialysis (HD) initiation has been suggested to decelerate estimated glomerular filtration rate (eGFR) decline but it remains uncertain which factors contributing to the renal benefit of VA creation.

Methods

One hundred and nine patientswith chronic kidney disease (CKD) (aged 65.3 years, Male:Female=58:51) transitioning to hemodialysis during January 2009 to December 2015 were recruited in this retrospectively single-center study and all had at least 3 estimated glomerular filtration rate (eGFR) measurements either before or after VA creation. The correlation between ratio of pre-/post-VA creation eGFR declined rate and other factors was examined through logistic regression.

Results

VA was created at mean age of 67.7 ± 11.8 and HD was initiated at 68.1 ± 11.8 years, respectively. Fifty one (46.8%) patients had decelerated eGFR declined rate after VA creation and were characterized by faster eGFR declined rate before VA creation (1.00 ± 1.41 vs 0.29 ± 0.23 ml/min per month, P < 0.001), regardless of age, gender and history of diabetes mellitus (DM) and hypertension. Biochemical surveys at the time of VA creation showed that lower serum creatinine level (3.57 ± 1.50 vs 4.49 ± 1.68 mg/dl, p = 0.003), lower serum albumin (3.50 ± 0.46 vs 3.72 ± 0.62 g/L, p = 0.02) and higher eGFR (19.04 ± 11.08 vs 14.57 ± 8.51 ml/min, p = 0.02) in patients with decelerated eGFR declined rate. Serum albumin level at VA creation showed reversely linear correlation with ratio of pre-/post-VA creation eGFR declined rate. A positive correlation between ratio of pre-/post-VA creation eGFR declined rate and HbA1c level at VA creation was disclosed in patients with DM.

Conclusion

It may be better to create VA earlier to postpone initiation of dialysis especially in patients with poor baseline conditions such as faster eGFR declined rate, low serum albumin level and, if patients with DM, higher HbA1c level.