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Safety of low-dose radiocontrast for interventional AV fistula salvage in stage 4 chronic kidney disease patients.

Publication ,  Journal Article
Kian, K; Wyatt, C; Schon, D; Packer, J; Vassalotti, J; Mishler, R
Published in: Kidney Int
April 2006

The Dialysis Outcomes Quality Initiative emphasizes increasing arteriovenous fistula prevalence, by promoting referral for fistula creation in patients with stage 4 chronic kidney disease (CKD). The aim is to provide an optimal access for initiation of dialysis, thus avoiding central venous catheter use. The endovascular management of nonmaturing fistulas is more complicated in these patients, where the expected benefit of catheter avoidance must be weighed against the risk of contrast induced nephropathy (CIN). This study reports on the safety of a low-dose radiocontrast regimen, used in performing endovascular fistula salvage procedures in patients with stage 4 CKD. All consecutive endovascular procedures performed over a 2-year period in patients with stage 4 CKD and nonmaturing access were identified. Data collected included the type of procedure, contrast volume per procedure, pre, 2- and 7-day creatinine, need for acute dialysis, and the type of access used to initiate dialysis. Total of 65 procedures were performed in 34 patients. The mean contrast volume was 7.8 ml per procedure. The incidence of CIN (25% increase in serum creatinine) was 4% at 2 days and 4.6% at 1 week. All values returned to baseline within 2 weeks, and no patient required acute dialysis. Among the 33 patients with nonmaturing fistulas, 20 initiated dialysis during the follow-up period, 15 (75%) using their fistula, and five (25%) using a catheter. This study demonstrates that in patients with advanced CKD, fistulas can be successfully salvaged using small contrast volumes with a low incidence of CIN.

Duke Scholars

Published In

Kidney Int

DOI

ISSN

0085-2538

Publication Date

April 2006

Volume

69

Issue

8

Start / End Page

1444 / 1449

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Time Factors
  • Safety
  • Retrospective Studies
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Kidney Diseases
  • Incidence
 

Citation

APA
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ICMJE
MLA
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Kian, K., Wyatt, C., Schon, D., Packer, J., Vassalotti, J., & Mishler, R. (2006). Safety of low-dose radiocontrast for interventional AV fistula salvage in stage 4 chronic kidney disease patients. Kidney Int, 69(8), 1444–1449. https://doi.org/10.1038/sj.ki.5000276
Kian, K., C. Wyatt, D. Schon, J. Packer, J. Vassalotti, and R. Mishler. “Safety of low-dose radiocontrast for interventional AV fistula salvage in stage 4 chronic kidney disease patients.Kidney Int 69, no. 8 (April 2006): 1444–49. https://doi.org/10.1038/sj.ki.5000276.
Kian K, Wyatt C, Schon D, Packer J, Vassalotti J, Mishler R. Safety of low-dose radiocontrast for interventional AV fistula salvage in stage 4 chronic kidney disease patients. Kidney Int. 2006 Apr;69(8):1444–9.
Kian, K., et al. “Safety of low-dose radiocontrast for interventional AV fistula salvage in stage 4 chronic kidney disease patients.Kidney Int, vol. 69, no. 8, Apr. 2006, pp. 1444–49. Pubmed, doi:10.1038/sj.ki.5000276.
Kian K, Wyatt C, Schon D, Packer J, Vassalotti J, Mishler R. Safety of low-dose radiocontrast for interventional AV fistula salvage in stage 4 chronic kidney disease patients. Kidney Int. 2006 Apr;69(8):1444–1449.
Journal cover image

Published In

Kidney Int

DOI

ISSN

0085-2538

Publication Date

April 2006

Volume

69

Issue

8

Start / End Page

1444 / 1449

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • United States
  • Time Factors
  • Safety
  • Retrospective Studies
  • Middle Aged
  • Male
  • Kidney Failure, Chronic
  • Kidney Diseases
  • Incidence