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      Hemodialysis reinitiation using a resurrected mummy fistula: a case report

      case-report
      Author(s): 1 , 1 , 2 ,
      Publication date (Electronic):
      Journal: BMC Nephrology
      Publisher: BioMed Central
      Keywords: Arteriovenous fistula, Occlusion, Revascularization, Ultrasound

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          Abstract

          Background

          Kidney allograft loss becomes an important cause of end-stage kidney disease and requires dialysis reinitiation. We report a case of a patient who restarted hemodialysis after his second kidney graft failure using a long-discarded autologous arteriovenous fistula.

          Case presentation

          A 62-year-old man was diagnosed with end-stage renal disease 20 year ago, and a native arteriovenous fistula was created for hemodialysis. After the patient received his first kidney transplantation, the hemodialysis fistula was discarded and chronically thrombosed for 13 years. When the patient experienced his second kidney graft loss and presented with uremia again, dialysis restart was needed. Under vascular ultrasound, but not x-ray, guidance, we successfully revascularized the patient’s chronically occluded, long-discarded arteriovenous fistula access and used it for hemodialysis. The resurrected fistula remained patent and clinically useable for hemodialysis up to 18 months.

          Conclusions

          This report provides the feasibility of ultrasound-guided transluminal angioplasty for the treatment of a mummy hemodialysis fistula, which could be considered when managing patients who need dialysis reinitiation.

          Electronic supplementary material

          The online version of this article (10.1186/s12882-018-1089-9) contains supplementary material, which is available to authorized users.

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          Most cited references14

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          Survival on dialysis post-kidney transplant failure: results from the Scientific Registry of Transplant Recipients.

          Rajiv Saran, Xiaoyu Jia, Shiqian Li … (2007)
          A substantial number of patients return to dialysis therapy after a renal transplant fails. It is not clear whether mortality increases among patients with graft failure relative to those on the waiting list who have not yet received a kidney transplant. Data from the Scientific Registry of Transplant Recipients were analyzed (N = 175,436). Cox regression with time-dependent covariates was used to compare mortality between post-graft failure dialysis patients and primary transplant candidates on dialysis therapy. Mortality hazard ratios (HRs) were adjusted for age, sex, race, cause of end-stage renal disease, pre-waiting list time on dialysis therapy, calendar year of wait-listing, and organ procurement organization. Overall, the post-graft failure dialysis group experienced a significant 78% greater mortality (HR, 1.78; P < 0.0001) relative to the transplant candidate group. The post-graft failure dialysis/transplant candidate HR was relatively constant across age groups, but significantly greater (P < 0.0001) among patients with diabetes (HR, 1.93) than among those without diabetes (HR, 1.69). The HR was greatest during the first week after graft failure (HR, 13.6; P < 0.0001) and decreased steadily thereafter. However, despite leveling off, the HR remained significantly elevated well after graft failure, including the 5- to 10-year period after graft failure. Based on national data, mortality among patients on dialysis therapy after primary graft failure increases significantly relative to mortality among patients still awaiting primary kidney transplantation. Additional studies are urgently needed to define the mechanism of the increased risk and strategies to decrease mortality.
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            Timing of return to dialysis in patients with failing kidney transplants.

            Miklos Z Molnar, Hirohito Ichii, James R. Lineen … (2013)
            In the last decade, the number of patients starting dialysis after a failed kidney transplant has increased substantially. These patients appear to be different from their transplant-naïve counterparts, and so may be the timing of dialysis therapy initiation. An increasing number of studies suggest that in transplant-naïve patients, later dialysis initiation is associated with better outcomes. Very few data are available on timing of dialysis reinitiation in failed transplant recipients, and they suggest that an earlier return to dialysis therapy tended to be associated with worse survival, especially among healthier and younger patients and women. Failed transplant patients may also have unique issues such as continuation of immunosuppression versus withdrawal or the need for remnant allograft nephrectomy with regard to dialysis reinitiation. These patients may have a different predialysis preparation work-up, worse blood pressure control, higher or lower serum phosphorus levels, lower serum bicarbonate concentration, and worse anemia management. The choice of dialysis modality may also represent an important question for these patients, even though there appears to be no difference in mortality between patients starting peritoneal versus hemodialysis. Finally, failed transplant patients returning to dialysis appear to have a higher mortality rate compared with transplant-naïve incident dialysis patients, especially in the first several months of dialysis therapy. In this review, we will summarize the available data related to the timing of dialysis initiation and outcomes in failed kidney transplant patients after returning to dialysis. © 2013 Wiley Periodicals, Inc.
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              Estimated glomerular filtration rate at reinitiation of dialysis and mortality in failed kidney transplant recipients.

              Miklos Z Molnar, Elani Streja, Csaba P. Kovesdy … (2012)
              Recent observational studies and a controlled trial suggest more favorable outcomes upon later dialysis initiation in chronic kidney disease. The role of estimated glomerular filtration rate (eGFR) in predicting outcome at reinitiation of dialysis in failed kidney transplant recipients is unclear. Five-year data in a large dialysis organization was linked to the 'Scientific Registry of Transplant Recipients' to identify 747 failed kidney transplant patients with CKD Stage 5, who had restarted dialysis therapy. A propensity score for early (eGFR>10.5 mL/min/1.73 m2) versus late reinitiation of dialysis was fit by logistic regression. The mortality hazard ratio (HR) was estimated across tertiles of the fitted score. Patients were 44±14 years old and included 42% women. Male gender {odds ratio (OR), [95% confidence interval (CI)]: 1.82 (1.22-2.73)}, diabetes mellitus [OR: 1.75 (1.14-2.68)] and peripheral vascular disease [OR: 3.55 (1.17-10.77)] were associated with higher odds of early dialysis reinitiation. Each mL/min/1.73 m2 higher eGFR was associated with 6% higher death risk in unadjusted model [HR: 1.06 (1.01-1.11)], and although not significant in fully adjusted models [HR: 1.02 (0.96-1.07)], it was significant in some subgroups including women and younger patients. The death HR of higher eGFR across lowest to highest tertiles of propensity score of early dialysis initiation (corresponding healthiest to sickest patients) were 1.10 (0.98-1.24), 1.00 (0.91-1.10) and 0.99 (0.92-1.07), respectively (P for trend<0.05), indicating a trend toward higher mortality risk with earlier dialysis initiation in the healthiest patients. Earlier return to dialysis therapy in failed kidney transplant patients tends to correlate with worse dialysis survival especially among healthiest and younger patients and women. Additional studies need to verify these findings.
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                Author and article information

                Contributors
                Ziming Wan: wanziming-001@163.com
                Qiquan Lai: 396090606@qq.com
                Bo Tu: bo.tu@dr.com
                Journal
                Journal ID (nlm-ta): BMC Nephrol
                Journal ID (iso-abbrev): BMC Nephrol
                Title: BMC Nephrology
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2369
                Publication date (Electronic): 26 October 2018
                Publication date PMC-release: 26 October 2018
                Publication date Collection: 2018
                Volume: 19
                Electronic Location Identifier: 296
                Affiliations
                [1 ]GRID grid.452206.7, Department of Nephrology, , The First Affiliated Hospital of Chongqing Medical University, ; 1 Youyi Road, Chongqing, 400016 China
                [2 ]GRID grid.452206.7, Department of Ultrasonography, , The First Affiliated Hospital of Chongqing Medical University, ; 1 Youyi Road, Chongqing, 400016 China
                Article
                Publisher ID: 1089
                DOI: 10.1186/s12882-018-1089-9
                PMC ID: 6203978
                PubMed ID: 30367625
                SO-VID: 8c0895b9-14bb-46ce-99de-3862e9400982
                Copyright © © The Author(s). 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 6 August 2018
                Date accepted : 9 October 2018
                Categories
                Subject: Case Report
                Custom metadata
                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Nephrology
                Keywords: arteriovenous fistula,occlusion,revascularization,ultrasound
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: arteriovenous fistula, occlusion, revascularization, ultrasound

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