Useless or just confusing and interesting

[cassandra]

The closure of arteriovenous fistula in kidney transplant recipients is associated with an acceleration of kidney function decline
 Authors
Laurent Weekers1,*,
Pauline Vanderweckene1,*,
Hans Pottel2,
Diego Castanares-Zapatero3,
Catherine Bonvoisin1,
Etienne Hamoir4,
Sylvie Maweja4,
Jean-Marie Krzesinski1,
Pierre Delanaye1 and
François Jouret1,5
1Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium
2KU Leuven Kulak, Department of Public Health and Primary Care, University of Leuven, Kortrijk, Belgium
3Intensive Care Unit, Cliniques universistaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
4Division of Abdominal Surgery and Transplantation, Department of Surgery, University of Liège Hospital (ULg CHU), Liège, Belgium
5Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of Liège, Liège, Belgium
Correspondence and offprint requests to: François Jouret; E-mail: francois.jouret@chu.ulg.ac.be
↵* These authors contributed equally to this work.
Received July 11, 2016.
Accepted August 24, 2016.

Abstract

Background The creation of arteriovenous fistula (AVF) may retard chronic kidney disease progression in the general population. Conversely, the impact of AVF closure on renal function in kidney transplant recipients (KTRs) remains unknown.
Methods From 2007 to 2013, we retrospectively categorized 285 KTRs into three groups: no AVF (Group 0, n = 90), closed AVF (Group 1, n = 114) and left-open AVF (Group 2, n = 81). AVF closure occurred at 653 ± 441 days after kidney transplantation (KTx), with a thrombosis:ligation ratio of 19:95. Estimated glomerular filtration rate (eGFR) was determined using the Modification of Diet in Renal Disease equation. Linear mixed models calculated the slope and intercept of eGFR decline versus time, starting at 3 months post-KTx, with a median follow-up of 1807 days (95% confidence interval 1665–2028).
Results The eGFR slope was less in Group 1 (−0.081 mL/min/month) compared with Group 0 (−0.183 mL/min/month; P = 0.03) or Group 2 (−0.164 mL/min/month; P = 0.09). Still, the eGFR slope significantly deteriorated after (−0.159 mL/min/month) versus before (0.038 mL/min/month) AVF closure (P = 0.03). Study periods before versus after AVF closure were balanced to a mean of 13.5 and 12.5 months, respectively, with at least 10 observations per patient (n = 99).
Conclusions In conclusion, a significant acceleration of eGFR decline is observed over the 12 months following the closure of a functioning AVF in KTRs.

[MooseMom]

A self contradictory word salad.

So, is the impact of AVF closure unknown?  Or, does AVF closure accelerate the decline of eGFR?  Which is it?

Mine was closed over two years ago, and I did not see any decline over the first 12 months after ligation.

These people are so desperate to be published that you read all sorts of nonsense in these medical journals.  I've been reading them for years and have rarely found anything useful and/or peer reviewed.  In fact, there have been too many scandals in the world of medical publishing for my liking.

Also, what on earth do they mean when they write that the creation of an AV fistula "may retard CKD progression in the general population"?  I've never heard of such a thing.  So, should nephs have their CKD patients who are in, say, stage 3 get a fistula to "retard progression" of their CKD?

[iolaire]

Authors all appear to be from Belgium.  When I received dialysis in Brussels everyone was on button holes, so my question is the AV closed via surgery or via natural closure?  If natural closure I wonder if button holes are more likely to close up (because they don't get the bulging that non button holes make).

[jmintuck]

I would NOT get my fistula closed up in any event, barring accidental somehow, which I would go right back to the doctor over. I don't care if my kidneys are now going to wake up now or why it would happen.

[MooseMom]

I would NOT get my fistula closed up in any event, barring accidental somehow, which I would go right back to the doctor over. I don't care if my kidneys are now going to wake up now or why it would happen.

Well, remember we are talking POST transplant.

Sometimes things happen that are beyond our control, and you have to make the best decision for yourself at the time.

I personally would have preferred to keep my fistula despite the fact that I had never had to use it and still had it after my tx.  But it became dangerous, and on the advice of my tx nephrologist, my PCP and my vascular surgeon, who was I to be stubborn about it?  I know that should my transplant fail and I have to go on dialysis, I'll have to have another fistula created, but that would be better than having my fistula make the blood vessels in my neck continue to grow and possibly start to grow into my head.

Never say never!

[jmintuck]

I would have to "keep" a vascular surgeon and get the odd angio to look for something like that at times, just for added protection.