Should the Arteriovenous Fistula Be Created before Starting Dialysis A Decision Analytic Approach 英文参考文献.docVIP

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Should the Arteriovenous Fistula Be Created before Starting Dialysis A Decision Analytic Approach 英文参考文献.doc

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Should the Arteriovenous Fistula Be Created before Starting Dialysis A Decision Analytic Approach 英文参考文献

ShouldtheArteriovenousFistulaBeCreatedbefore StartingDialysis?:ADecisionAnalyticApproach SwapnilHiremath1,2,3*,GregKnoll1,2,MiltonC.Weinstein3 1Division of Nephrology, Kidney Research Center, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, 2Clinical Epidemiology Program, Ottawa Hospital ResearchInstitute,Ottawa,Ontario,Canada,3DepartmentofHealthPolicyandManagement,HarvardSchoolofPublicHealth,Boston,Massachusetts,UnitedStatesof America Abstract Background: Anarteriovenous fistula (AVF)is consideredthe vascularaccess ofchoice,but uncertainty existsabout the optimaltime forits creationinpre-dialysis patients. Theaim ofthis study wastodeterminetheoptimalvascularaccess referralstrategyforstage4(glomerularfiltrationrate,30ml/min/1.73m2)chronickidneydiseasepatientsusingadecision analyticframework. Methods:AMarkovmodelwascreatedtocomparetwostrategies:referallstage4chronickidneydiseasepatientsforan AVF versus wait until the patient starts dialysis. Data from published observational studies were used to estimate the probabilitiesusedinthemodel.AMarkovcohortanalysiswasusedtodeterminetheoptimalstrategywithlifeexpectancy andqualityadjustedlifeexpectancyastheoutcomes.Sensitivityanalyses,includingaprobabilisticsensitivityanalysis,were performedusingMonteCarlosimulation. Results:Thewaitstrategyresultsinahigherlifeexpectancy(66.6versus65.9months)andqualityadjustedlifeexpectancy (38.9versus38.5qualityadjustedlifemonths)thanimmediateAVFcreation.Itwasrobustacrossalltheparametersexcept athigherratesofprogressionandlowerratesofischemicstealsyndrome. Conclusions:EarlycreationofanAVF,asrecommendedbymostguidelines,maynotbethepreferredstrategyinallpre- dialysis patients. Further research on cost implications and patient preferences for treatment options needs to be done beforerecommendingearlyAVFcreation. Citation:HiremathS,KnollG,WeinsteinMC(2011)ShouldtheArteriovenousFistulaBeCreatedbeforeStartingDialysis?:ADecisionAnalyticApproach.PLoS ONE6(12):e28453.doi:10.1371/journal.