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

Research output: Contribution to journalArticle

5 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

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Arteriovenous Fistula
Blood Vessels
Renal Dialysis
Cohort Studies
Prospective Studies
Transplants
Survival
Life Expectancy
Vascular Access Devices
Republic of Korea
Chronic Kidney Failure
Registries
Diabetes Mellitus
Quality of Life

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Park, Hoon Suk ; Kim, Woo Jeong ; Kim, Yong Kyun ; Kim, Hyung Wook ; Choi, Bum Soon ; Park, Cheol Whee ; Kim, Young Ok ; Yang, Chul Woo ; Kim, Yong Lim ; Kim, Yon Su ; Kang, Shin-Wook ; Kim, Nam Ho ; Jin, Dong Chan. / Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis : A Prospective Cohort Study. In: American Journal of Nephrology. 2016 ; Vol. 43, No. 2. pp. 120-128.
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title = "Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis: A Prospective Cohort Study",
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.",
author = "Park, {Hoon Suk} and Kim, {Woo Jeong} and Kim, {Yong Kyun} and Kim, {Hyung Wook} and Choi, {Bum Soon} and Park, {Cheol Whee} and Kim, {Young Ok} and Yang, {Chul Woo} and Kim, {Yong Lim} and Kim, {Yon Su} and Shin-Wook Kang and Kim, {Nam Ho} and Jin, {Dong Chan}",
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Park, HS, Kim, WJ, Kim, YK, Kim, HW, Choi, BS, Park, CW, Kim, YO, Yang, CW, Kim, YL, Kim, YS, Kang, S-W, Kim, NH & Jin, DC 2016, 'Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis: A Prospective Cohort Study', American Journal of Nephrology, vol. 43, no. 2, pp. 120-128. https://doi.org/10.1159/000444889

Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis : A Prospective Cohort Study. / Park, Hoon Suk; Kim, Woo Jeong; Kim, Yong Kyun; Kim, Hyung Wook; Choi, Bum Soon; Park, Cheol Whee; Kim, Young Ok; Yang, Chul Woo; Kim, Yong Lim; Kim, Yon Su; Kang, Shin-Wook; Kim, Nam Ho; Jin, Dong Chan.

In: American Journal of Nephrology, Vol. 43, No. 2, 01.04.2016, p. 120-128.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of Outcomes with Arteriovenous Fistula and Arteriovenous Graft for Vascular Access in Hemodialysis

T2 - A Prospective Cohort Study

AU - Park, Hoon Suk

AU - Kim, Woo Jeong

AU - Kim, Yong Kyun

AU - Kim, Hyung Wook

AU - Choi, Bum Soon

AU - Park, Cheol Whee

AU - Kim, Young Ok

AU - Yang, Chul Woo

AU - Kim, Yong Lim

AU - Kim, Yon Su

AU - Kang, Shin-Wook

AU - Kim, Nam Ho

AU - Jin, Dong Chan

PY - 2016/4/1

Y1 - 2016/4/1

N2 - 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.

AB - 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.

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U2 - 10.1159/000444889

DO - 10.1159/000444889

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JO - American Journal of Nephrology

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