Abstract: FR-PO767
Buttonhole Versus Stepladder Cannulation for Arteriovenous Fistulas for Home Hemodialysis Patients: A Randomized Controlled Feasibility Trial
Session Information
- Hemodialysis: Vascular Access - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Dialysis
- 603 Hemodialysis: Vascular Access
Authors
- Zimmerman, Deborah Lynn, Ottawa Hospital, Ottawa, Ontario, Canada
- MacRae, Jennifer M., University of Calgary, Calgary, Alberta, Canada
- Hollingsworth, Brittany, The Ottawa Hospital Research Institute , Ottawa, Ontario, Canada
- Chan, Christopher T., Toronto General Hospital, Toronto, Ontario, Canada
- Nesrallah, Gihad E., The University of Western Ontario, Toronto, Ontario, Canada
- McFarlane, Philip, St. Michael's Hospital, Toronto, Alberta, Canada
- Copland, Michael A., University of British Columbia, Vancouver, British Columbia, Canada
- Huang, Shih-Han S., London Health Sciences Centre, London, Ontario, Canada
Background
The need for more rigorous studies to address the uncertainty about the risk and benefits of buttonhole versus stepladder cannulation for arteriovenous fistula (AVF) was highlighted in the recently published Canadian Society of Nephrology guidelines on intensive home hemodialysis (HHD). Therefore, our purpose was to determine the feasibility of doing a multi-centre randomized controlled trial of buttonhole versus step-ladder cannulation in patients training to do HHD with an AVF.
Methods
Patients were to be recruited from 7 tertiary care Canadian hospitals with expertise in home hemodialysis. Inclusion criteria were 1) adult patients training for HHD, 2) AVF, 3) life expectancy greater than 12 months, and 4) able to give informed consent. Exclusion criteria were: 1) potential loss to followup within 12 months of training, 2) allergy to mupirocin, 3) need for intradermal lidocaine, 4) short segments or aneurysms in the AVF that the care team felt required buttonhole cannulation, and 5) mechanical heart values. For our feasibility outcome, we determined that 70% of eligible patients needed to be randomized.
Results
Patients were recruited from November 2013 to Sept 2015. A total of 167 patients began training for HHD; average age 54 (±15) years, 55% male, 53% had a central venous catheter (CVC) or arteriovenous graft (AFG). Sixty patients were eligible to participate; only 14 (23%) were randomized. Of the eligible patients that we not randomized, the majority either declined study participation (16) or stated a preference for buttonhole cannulation (12). Of the 107 patients who were ineligible to participate 79 patients had a CVC and 10 patients had an AVG. Other reasons for exclusion included; did not complete training (8), potential to be lost to followup (6), buttonhole required (4), stepladder required (1), and mechanical heart values (1).
Conclusion
In spite of the stated equipoise about the optimal cannulation technique for patients with an AVF who are training for HHD, we were unable to demonstrate that a randomized controlled trial would be feasible in Canada.
Funding
- Commercial Support – Baxter