Patency Outcomes of Arteriovenous Fistulas and Grafts for Hemodialysis Access: A Trade-Off between Nonmaturation and Long-Term Complications.
arteriovenous fistula
arteriovenous graft
dialysis
patency
vascular access
Journal
Kidney360
ISSN: 2641-7650
Titre abrégé: Kidney360
Pays: United States
ID NLM: 101766381
Informations de publication
Date de publication:
24 09 2020
24 09 2020
Historique:
received:
14
04
2020
accepted:
20
07
2020
entrez:
4
4
2022
pubmed:
23
7
2020
medline:
8
4
2022
Statut:
epublish
Résumé
Arteriovenous fistulas (AVFs) for hemodialysis (HD) are often associated with better outcomes than arteriovenous grafts (AVGs). We aimed to investigate vascular access (VA) outcomes and assessed if AVF nonmaturation outweighs long-term complications of AVGs. In this multicenter, retrospective cohort study in The Netherlands, 1- and 3-year primary, primary assisted, secondary, and functional patency rates were calculated, and the incidence of adverse events and procedures was assessed. Functional patency of RCAVFs, upper arm AVFs, and AVGs was compared using Cox analyses. In total, 1041 patients who received their first VA were included, of whom 863 had VAs that successfully matured. These patients were analyzed with a median follow-up of 25 months. The 1-year functional patency rates were 67%±2.0% for RCAVFs, 83%±2.0% for upper arm AVFs, and 85%±3.5% for AVGs. Three-year functional patency rates were 62%±2.0% for RCAVFs, 74%±2.0% for upper arm AVFs, and 69%±5% for AVGs. AVGs required more procedures per year (3.3 per year) of functional patency when compared with upper arm AVFs (1.8 per year). The functional patency of AVFs and AVGs is comparable, although AVGs required more interventions to maintain usability for HD. The choice of VA is a trade-off between short-term advantages, favoring AVGs, and long-term advantages, favoring AVFs. Which VA is most appropriate depends on the patient's prognosis and preferences.
Sections du résumé
Background
Arteriovenous fistulas (AVFs) for hemodialysis (HD) are often associated with better outcomes than arteriovenous grafts (AVGs). We aimed to investigate vascular access (VA) outcomes and assessed if AVF nonmaturation outweighs long-term complications of AVGs.
Methods
In this multicenter, retrospective cohort study in The Netherlands, 1- and 3-year primary, primary assisted, secondary, and functional patency rates were calculated, and the incidence of adverse events and procedures was assessed. Functional patency of RCAVFs, upper arm AVFs, and AVGs was compared using Cox analyses.
Results
In total, 1041 patients who received their first VA were included, of whom 863 had VAs that successfully matured. These patients were analyzed with a median follow-up of 25 months. The 1-year functional patency rates were 67%±2.0% for RCAVFs, 83%±2.0% for upper arm AVFs, and 85%±3.5% for AVGs. Three-year functional patency rates were 62%±2.0% for RCAVFs, 74%±2.0% for upper arm AVFs, and 69%±5% for AVGs. AVGs required more procedures per year (3.3 per year) of functional patency when compared with upper arm AVFs (1.8 per year).
Conclusions
The functional patency of AVFs and AVGs is comparable, although AVGs required more interventions to maintain usability for HD. The choice of VA is a trade-off between short-term advantages, favoring AVGs, and long-term advantages, favoring AVFs. Which VA is most appropriate depends on the patient's prognosis and preferences.
Identifiants
pubmed: 35369548
doi: 10.34067/KID.0000462020
pii: K3602020000046
pmc: PMC8815607
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
916-924Informations de copyright
Copyright © 2020 by the American Society of Nephrology.
Déclaration de conflit d'intérêts
All authors have nothing to disclose.
Références
Nephrol Dial Transplant. 2013 May;28(5):1085-92
pubmed: 23543595
Nephrol Dial Transplant. 2007 May;22 Suppl 2:ii88-117
pubmed: 17507428
J Vasc Surg. 2002 Mar;35(3):603-10
pubmed: 11877717
Semin Dial. 2012 Nov-Dec;25(6):640-8
pubmed: 23173892
Clin J Am Soc Nephrol. 2007 Jul;2(4):786-800
pubmed: 17699495
J Vasc Access. 2014;15 Suppl 7:S28-32
pubmed: 24817451
J Vasc Surg. 2011 Mar;53(3):713-9; discussion 719
pubmed: 21129897
Eur J Vasc Endovasc Surg. 2017 Oct;54(4):513-522
pubmed: 28843984
Kidney Int. 2002 Jan;61(1):305-16
pubmed: 11786113
World J Surg. 2018 Jun;42(6):1895-1903
pubmed: 29188313
Am J Kidney Dis. 2014 Mar;63(3):464-78
pubmed: 24183112
Clin J Am Soc Nephrol. 2013 May;8(5):810-8
pubmed: 23371955
Eur J Vasc Endovasc Surg. 2018 Jun;55(6):757-818
pubmed: 29730128