Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis: A Prospective Cohort Study

Hoon Suk Park, Woo Jeong Kim, Yong Kyun Kim, Hyung Wook Kim, Bum Soon Choi, Cheol Whee Park, Young Ok Kim, Chul Woo Yang, Yong Lim Kim, Yon Su Kim, Shin Wook Kang, Nam Ho Kim, Dong Chan Jin

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10 Citations (Scopus)

Abstract

Background: Poor vessel quality and limited life expectancy in the elderly may make arteriovenous fistula (AVF) less ideal than arteriovenous graft (AVG) or catheter for vascular access (VA) in hemodialysis (HD). Methods: A total of 946 adult incident HD patients from clinical research center registry for end-stage renal disease prospective cohort in South Korea were analyzed for outcomes with AVF and AVG. Results: Overall, AVF was associated with better patient survival only in male (p < 0.001) and diabetic (p = 0.004) patients, although it was superior to AVG in access patency, regardless of diabetes mellitus status and gender. AVG (vs. AVF; hazard ratio (HR) 2.282; 95% CI 1.071-4.861; p = 0.032) was associated with poor patient survival. In elderly patients (≥65 years), AVF was associated with survival benefit only in male (p < 0.001) and diabetic (p = 0.04) patients, and with better access patency only in female (p = 0.05) and diabetic (p = 0.04) patients. AVG (vs. AVF; HR 3.158; 95% CI 1.080-9.238; p = 0.036) was associated with poor patient survival. In septuagenarian patients, AVF was associated only with survival benefit (p = 0.01) and there was no advantage in access patency (p = 0.12). However, AVF was superior to AVG in both access patency (p = 0.001) and patient survival (p = 0.03) even with propensity matching. Conclusion: AVF is the more desirable VA and its survival benefits warrant its consideration in septuagenarian patients although a prolonged life expectancy is essential to realize the potential benefits of AVF.

Original languageEnglish
Pages (from-to)120-128
Number of pages9
JournalAmerican Journal of Nephrology
Volume43
Issue number2
DOIs
Publication statusPublished - 2016 Apr 1

All Science Journal Classification (ASJC) codes

  • Nephrology

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    Park, H. S., Kim, W. J., Kim, Y. K., Kim, H. W., Choi, B. S., Park, C. W., Kim, Y. O., Yang, C. W., Kim, Y. L., Kim, Y. S., Kang, S. W., Kim, N. H., & Jin, D. C. (2016). Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis: A Prospective Cohort Study. American Journal of Nephrology, 43(2), 120-128. https://doi.org/10.1159/000444889