Initiation of Hemodialysis at One Month Following Fistulogram in Patients with Stage IV and V Chronic Kidney Disease

Abstract

OBJECTIVE Previous studies have demonstrated that small amounts of contrast used in access related interventions had limited effects on the rate of progression of chronic kidney disease (CKD) after fistulography, but studies are limited and heterogeneous. In this study, we aimed to evaluate the risk of progression to dialysis (HD) within one month and associated factors after fistulography for patients with CKD.______ METHODS A retrospective review at a single institution of the electronic medical records of all patients with diagnosed CKD stage IV and V, not yet on HD, who underwent fistulography from January 1st, 2014 to December 31st, 2018 was performed. The primary outcome was progression to HD within one month. Additional variables and the association with the primary outcome such as medical comorbidities, contrast type or volume were assessed. _______ RESULTS A total of 34 patients underwent 41 fistulograms prior to HD initiation. Progression to HD within one month of fistulogram occurred in 7 patients, all of which were CKD V status. The mean time between fistulogram and HD was 271 days for 31 of 34 patients who ultimately progressed to HD. Those with CKD IV began HD in 549 days on average, while those with CKD V began HD in 190 days on average. Three patients had not initiated HD at a mean of 539 days of follow-up. The only factors associated with progression to HD within one month i ncluded use of isovue (p=0.005) and elevated contrast volume, with a mean of 40 mL (p=0.027).______ CONCLUSION Patients who progressed to HD within one month after fistulography were more likely to have received isovue-300 and significantly larger volumes of iodinated contrast. Fistulograms for CKD IV patients did not appear to have a significant perioperative risk of progression to HD. Further study should investigate the safety of iodinated and alternative (e.g. carbon dioxide) contrast media in fistulography or duplex-based HD access procedures for CKD patients, especially CKD V, not yet on HD.