Back-up Arteriovenous Fistulas in Peritoneal Dialysis Patients: A Systematic Review and Meta-analysis
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Résumé
<h3>Rationale & Objective</h3> Peritoneal dialysis (PD) is a dialysis modality limited by the potential need of transferring to hemodialysis. Optimal hemodialysis vascular access is an arteriovenous fistula. Back-up arteriovenous fistula (bAVF) is a strategy to prevent central venous catheter (CVC) insertion, but its use in the PD population has not been systematically reviewed. <h3>Study Design</h3> Systematic review and meta-analysis. <h3>Setting & Study Populations</h3> Studies including PD patients with a bAVF and the associated outcomes, including risk of hemodialysis transfer with a CVC and the proportion of bAVFs used. <h3>Selection Criteria for Studies</h3> Retrospective or prospective, observational studies, non-randomized or randomized controlled trials. <h3>Data Extractions</h3> Vascular access at time of hemodialysis transfer (bAVF vs CVC) for patients with and without a bAVF. The data on bAVF outcomes included bAVFs that stopped working, were never used, and the number of patients requiring hemodialysis. <h3>Analytical Approach</h3> Random-effects meta-analysis and meta-proportional analysis were conducted, with risk of bias within studies assessed using the Newcastle-Ottawa Scale. <h3>Results</h3> We screened 1,855 studies, 11 of which met the inclusion criteria, comprising 598 (62%) patients with a bAVF and 368 (38%) without. The proportion of bAVFs never used was 69% (95% confidence intervals [CI], 0.58-0.80; <i>I</i><sup>2</sup>=86.2%). Meta-analysis of 8 studies found no difference in hemodialysis transfer between patients with a bAVF and those without (hazard ratio, 1.14; 95% CI, 0.86-1.51). However, the risk of hemodialysis transfer with a CVC was significantly lower in patients with a bAVF (hazard ratio, 0.43; 95% CI, 0.17-0.68). <h3>Limitations</h3> Substantial heterogeneity between the studies and large number of studies with poor quality. <h3>Conclusions</h3> bAVF was associated with a high rate of non-utilization but a lower risk of starting hemodialysis via a CVC. Future studies assessing long-term clinical outcomes may provide further insights into the role of bAVF creation in shaping dialysis unit policies. <h3>Plain-Language Summary</h3> Peritoneal dialysis (PD) is limited by hemodialysis transfer. The optimal vascular access in hemodialysis is the arteriovenous fistula, yet requirements for maturation often necessitate a central venous catheter (CVC) insertion in acute transfers from PD. A back-up arteriovenous fistula (bAVF) is a strategy used to avoid CVC use in such situations. However, no consensus is currently available on the best approach for bAVF in PD. By conducting a systematic review, we found that 69% of bAVFs were never used. Nevertheless, bAVFs reduced the risk of hemodialysis transfer with a CVC by almost 60%. The studies in the review were small in number and exhibited high heterogeneity, emphasizing that further research is needed to clarify the role and benefits of a bAVF in PD patients.
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Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,023 | 0,004 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
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