2023-10-24 12:22:11
Title: OASIS Study Aims to Determine Best Vascular Access for Older Hemodialysis Patients
Introduction:
A research project called OASIS (Optimizing Access Surgery In Senior hemodialysis patients), led by Dr. Maarten Snoeijs from Maastricht UMC+, is focused on finding the best vascular access for older hemodialysis patients. This study aims to compare the effectiveness and complications of three types of access points: autologous arteriovenous fistula, plastic arteriovenous graft, and central venous dialysis catheter.
The Need for Research:
There has been uncertainty regarding the optimal treatment option, particularly for vulnerable elderly individuals. Randomized research is crucial to provide a fair comparison of the three vascular access points.
Different Vascular Access Options:
The three types of vascular access available for hemodialysis patients are autologous arteriovenous fistula, plastic arteriovenous graft, and central venous dialysis catheter. Autologous arteriovenous fistula involves creating an enlarged vein at the wrist or elbow, which can be repeatedly punctured after a maturation period. Plastic arteriovenous graft is immediately operational but often causes stenosis and thrombosis in the long term. Central venous dialysis catheter is a permanent catheter placed via the jugular vein, which is immediately usable but carries a risk of line sepsis and increased mortality.
Changing Perspectives on Vascular Access:
Recent research has led to a more critical examination of the recommended approach of “fistula first, catheter last.” Studies based on national dialysis registrations may introduce selection bias and not accurately reflect the complications and costs associated with different access points. The revised recommendation by the Kidney Disease Outcomes Quality Initiative (KDOQI) now emphasizes the importance of choosing the right access for the right patient at the right time, especially for older hemodialysis patients.
Overview of the OASIS Study:
The OASIS study, funded by Healthcare Insurers Netherlands, aims to determine the best vascular access for older dialysis patients. It involves a collaboration between multiple medical disciplines and focuses on patient outcomes, including pain, bleeding, and concerns about vascular access-related problems. The study also examines the costs associated with different access options.
Challenges and Progress:
The OASIS study commenced in late 2019 and has recruited 120 out of the intended 195 participants. The COVID-19 pandemic has slowed down the recruitment process, necessitating a longer follow-up than initially planned. However, adjustments have been made to the study design to account for the extended follow-up. The inclusion phase is expected to be completed within a year, with the study concluding in approximately two years.
Collaboration and Future Research:
While the OASIS study is unique in comparing three treatment options, other randomized studies in Canada, Austria, and the US are also evaluating vascular access in elderly dialysis patients. Close collaboration between these research groups is expected to ensure comprehensive analysis and collective dissemination of results. Additionally, Dr. Snoeijs is involved in the FLOW project, which focuses on the maintenance of vascular access once it is in use and aims to determine the optimal timing for angioplasty.
Conclusion:
The ongoing OASIS study led by Dr. Maarten Snoeijs aims to provide evidence-based recommendations on the best vascular access for older hemodialysis patients. By comparing the outcomes and complications of different access points, the study aims to optimize patient care and improve the quality of life for dialysis patients.]
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