Predictive Factors for Unsuccessful Use of Arteriovenous Fistula in a Population of End-Stage Renal Disease Patients in Southeastern Mexico.

BACKGROUND: An arteriovenous fistula (AVF) is the preferred vascular access for long-term hemodialysis. The main disadvantage of AVF is the rate of nonmaturation or unsuccessful use for hemodialysis (FUHD). We described our findings in AVF creation and possible risk factors associated with FUHD. METHODS: This is a retrospective study of AVFs during a 6-year period. Variables collected at the time of creation were demographics, comorbidities, replacement therapy, preoperative laboratory tests, and estimated 6-month mortality on hemodialysis. All AVFs were created in the upper arms. Outcomes were FUHD, cannulation failure, and cumulative survival. Univariate and multivariate analyses were performed to find possible risk factors for FUHD. RESULTS: AVFs were created in 78 patients. Average age was 36.3 years, and 74.4% were male. Mean body mass index was 24.5 kg/m2. The most common etiologies were glomerulopathy (53.6%) and diabetes mellitus (13.4%). Estimated six-month mortality was 4.2%. One patient underwent AVF before hemodialysis (mean dialysis time 2.2 years). Nineteen AVFs were considered FUHD (23.2%). Cannulation failure was 15.9%. AVF 1-year and 3-year survival was 67.8% and 63.5%, respectively. FUHD had higher estimated six-month mortality on hemodialysis, shorter prothrombin time, and lower serum albumin level than successful AVF (univariate analysis) (P < 0.05) Short prothrombin time and albumin were confirmed for FUHD (multivariate analysis). A 3.3-gr/dL serum albumin cutoff point (area under the curve, 0.715; receiver operating characteristic) (P < 0.05) was determined for FUHD. CONCLUSIONS: The population referred for AVF creation possesses different characteristics in our center. Good AVF outcomes can be achieved. Preoperative serum albumin level and prothrombin time could be the possible risk factors associated with unsuccessful AVF use.

Patient survival scale after kidney transplant from deceased donors in Veracruz, Mexico / Escala de sobrevida de pacientes después de trasplante renal de donantes fallecidos en Veracruz, México

Background: The Estimated Post Transplant Survival (EPTS) score is calculated based on age, the presence of diabetes mellitus, years on dialysis, and prior organ transplant. The EPTS score has been validated in other countries. Objective: To apply and assess the EPTS score in our population of deceased-donor kidney transplants. Materials and methods: Retrospective study of adult deceased-donor kidney transplants from January, 2003, to December, 2016. For the statistical analysis it was used Spearman's correlation, receiver-operator curves (ROC) and Kaplan-Meier curves. A p value < 0.05 was considered statistically significant. Results: 176 adult deceased-donor kidney transplants were included. Medium age was 34.7 ± 11 years; 53.4% were men, 4% diabetics; mean dialysis time was 5.5 ± 3.9 years and 4% had a prior organ transplant. The medium of EPTS score was 16.3 ± 18.7 (1 94). Spearman's correlation was −0.394 (p = 0.0001). C value (ROC) was 0.64 ± 0.6 (95% CI, 0.52-0.75) (p = 0.011). Medium survival calculated with Kaplan-Meier in patients with an EPTS score < 20, was 10.2 ± 0.3 years (95% CI, 9.5-10.9) versus patients with EPTS score > 20: 7.03 ± 0.9 years (95% CI, 5.1-8.9) (p = 0.001). Each 20% increase of EPTS, patient survival time diminished (p = 0.0001). Conclusions: The EPTS score is a useful tool for establishing survival in adult Mexican recipients of deceased-donor kidney transplants.

Introducción: la escala de sobrevida estimada postrasplante (EPTS) se calcula a partir de la edad, la presencia de diabetes mellitus, el tiempo en diálisis y el trasplante previo. La EPTS ha sido previamente validada en otros sitios. Objetivo: aplicar y evaluar la escala EPTS en nuestra población de trasplantes de donante fallecido. Material y métodos: estudio retrospectivo de trasplantes renales de donantes adultos fallecidos, llevados a cabo entre enero de 2003 y diciembre de 2016. Para el análisis estadístico se utilizaron correlación de Spearman, curvas de ROC y Kaplan-Meier y se consideró significativa una p < 0.05. Resultados: se incluyeron 176 trasplantes de donantes adultos fallecidos; 53.4% fueron hombres, 4% diabéticos; la edad media fue de 34.7 ± 11 años; el tiempo medio en diálisis fue de 5.5 ± 3.9 años y 4% tuvo trasplante previo. La media de la escala EPTS fue de 16.3 ± 18.7 (rango 1-94). La correlación Spearman fue −0.394 (p = 0.0001). El valor C de la curva ROC fue de 0.64 ± 0.6 (IC 95% 0.52-0.75) (p = 0.011). La supervivencia media calculada con Kaplan-Meier en pacientes con EPTS < 20 fue 10.2 ± 0.3 años (IC 95% 9.5-10.9) frente a los pacientes con EPTS > 20: 7.03 ± 0.9 años (IC 95% 5.1-8.9) (p = 0.001). Por cada 20% que se incrementó la EPTS, la supervivencia del paciente fue menor (p = 0.0001). Conclusiones: la escala EPTS es una buena herramienta para establecer la supervivencia en pacientes adultos mexicanos receptores de trasplante renal de donante fallecido.

[Implementation of a clinical prediction tool in renal transplant recipients]. / Aplicación de una herramienta de predicción pronóstica en receptores de trasplante renal.

BACKGROUND: Kasiske developed a tool for predicting the risk of 5-year graft loss. We analyzed our results using this model. METHODS: 109 deceased donor kidney transplants were included. 5-year probability of graft survival was calculated during transplantation, seven days after transplantation and 1-year after transplantation. Z-test and ROC curves were used for proportion differences and discrimination ability. RESULTS: Mean age of donor and recipient was 33.7 and 33.9 years, respectively. 59.6% died due to trauma. Mean of years on dialysis was 3.7. 22.9% of patients had delayed graft function (DGF). Calculated 5-year probability of graft survival during transplantation time was 74.1%; 7 days after transplantation, 74.9%; and one year after transplantation, 76.4%. 5-year death censored graft survival was 64.9%. There were no differences between death-censored graft survival and calculated probabilities (Z-test), with a C-statistic value of 0.54 ± 0.6 (95%CI 0.42-0.65, p = 0.5) and 0.51 ± 0.6 (0.39-0.63, 95% CI, p = 0. 7) for transplant time and seven days after. C-statistic value 1-year after transplantation was 0.68 ± 0.8 (95%CI 0.52-0.84, p = 0.02). CONCLUSION: Only calculated 5-year graft survival one year after transplantation had modest prediction ability.

Introducción: Kasiske desarrolló una herramienta para predecir el riesgo de pérdida del injerto a cinco años. Se analizaron los resultados utilizando este modelo. Métodos: se incluyeron 109 pacientes trasplantados de donantes fallecidos. La probabilidad de sobrevida del injerto a cinco años fue calculada al momento del trasplante, a los siete días y al año. La prueba Z y las curvas ROC fueron utilizadas para diferencias de proporción y capacidad de discriminación. Resultados: la media de edad del donador y del receptor fue 33.7 y 33.9 años, respectivamente. El 59.6% falleció de trauma. La media de años en diálisis fue de 3.7. El 22.9% tuvo retraso en la función del injerto. La probabilidad de sobrevida a cinco años del injerto en el momento del trasplante fue de 74.1%; siete días después fue de 74.9% y al año 76.4%. La sobrevida actuarial a cinco años del injerto fue 64.9%. No hubo diferencias entre la sobrevida del injerto y las probabilidades calculadas (prueba Z) con valor estadístico C de 0.54 ± 0.6 (intervalo de confianza al 95% [IC 95%] 0.42-0.65, p = 0.5) y 0.51 ± 0.6 (IC 95% 0.39-0.63, p = 0.7) para el tiempo de trasplante y al séptimo día. El valor estadístico C después del trasplante a un año fue de 0.68 ± 0.8 (IC 95% 0.52-0.84, p = 0.02). Conclusión: existió una predicción modesta al calcular la sobrevida del injerto a cinco años a un año posterior al trasplante.