title: Obesity Increases the Risk of Primary Nonfunction and Early Access Loss, and Decreases Overall Patency in Patients Who Underwent Hemodialysis Reliable Outflow Device Placement.
abstract: BACKGROUND
  Hemodialysis reliable outflow (HeRO) catheters were introduced in 2008, and have been since providing a reliable alternative for hemodialysis patients who are deemed "access challenged." However, its outcomes have not been extensively investigated due to its relatively young age. Here, we report our 6-year single institution experience, and demonstrate the significant impact of obesity on HeRO graft outcomes, an aspect not previously studied in the literature.
  
  
  METHODS
  Patients who underwent HeRO graft placement at the University of Illinois Hospital between April 2009 and August 2015 were included retrospectively. Data were collected from patients' electronic medical records and analyzed using SPSS software.
  
  
  RESULTS
  Thirty-three patients who underwent 34 HeRO catheter placements were included. Mean age was 47 ± 12 years, and mean body mass index (BMI) was 30.75 ± 10.22. Median follow-up was 635 days. Overall catheter-related complications were thrombosis (70.59%), infection (20.59%), arterial steal (8.82%), and pseudoaneurysms requiring intervention (8.82%). Overall primary and secondary patency rates after 6 and 12 months were 31.25%, 25%, 78.13%, and 71.86%, respectively. Primary nonfunction rate was 14.7%. Obese patients had significantly higher rate of primary nonfunction (38.46% vs. 0%, P = 0.0046), and relative risk 3.62 (95% confidence interval [CI] 2.01-6.52). They also had a significantly decreased rate of graft patency after 12 months (10.53% vs. 53.85%, P = 0.0227), leading to a relative risk of "early" graft loss within 1 year of 5.12 (95% CI 1.26-20.83). Overall median graft patency in obese patients was significantly shorter than that of nonobese patients (311 vs. 1295 days, P = 0.014). BMI, as a continuous variable, was a significant predictor of primary nonfunction (P = 0.046) and early graft loss (0.020) when tested against age, sex, race, and diabetes in a multivariate logistic regression analysis.
  
  
  CONCLUSIONS
  HeRO catheters offer a reliable, and possibly the last, alternative in hemodialysis access-challenged patients. In our population, obesity was a significant risk factor for primary nonfunction, early graft loss, and a shorter overall graft patency. BMI, as a continuous variable, can serve as a predictor of primary nonfunction and early graft loss after adjustment for age, race, sex, and diabetes. Obesity's effect on HeRO catheters has not been amply addressed; therefore further prospective studies are warranted.
authors.affiliation: Department of Surgery, University of Illinois at Chicago, Chicago, IL. Electronic address: snaffouj@uic.edu.
authors.forename: Samer A
authors.initials: SA
authors.lastname: Naffouje
authors.affiliation: Department of Surgery, University of Illinois at Chicago, Chicago, IL.
authors.forename: Ivo
authors.initials: I
authors.lastname: Tzvetanov
authors.affiliation: Department of Radiology, University of Illinois at Chicago, Chicago, IL.
authors.forename: James T
authors.initials: JT
authors.lastname: Bui
authors.affiliation: Department of Radiology, University of Illinois at Chicago, Chicago, IL.
authors.forename: Ron
authors.initials: R
authors.lastname: Gaba
authors.affiliation: Department of Surgery, University of Illinois at Chicago, Chicago, IL.
authors.forename: Karrel
authors.initials: K
authors.lastname: Bernardo
authors.affiliation: Department of Surgery, University of Illinois at Chicago, Chicago, IL.
authors.forename: Hoonbae
authors.initials: H
authors.lastname: Jeon
mesh_terms: D000328:Adult; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D015992:Body Mass Index; D002641:Chicago; D057286:Electronic Health Records; D005260:Female; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D011475:Prosthesis Failure; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D062666:Vascular Access Devices; D014654:Vascular Patency