Vascular Access Choice in Incident Hemodialysis Patients

Drew, David A.; Lok, Charmaine E.; Cohen, Joshua T.; Wagner, Martin; Tangri, Navdeep; Weiner, Daniel E.

doi:10.1681/asn.2013111236

Cited by 121 publications

(125 citation statements)

References 25 publications

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“…Similarly, in a decision analysis, men with diabetes had a modest survival benefit at younger ages with a fistula first strategy, but this benefit progressively diminished with increasing age. For women with diabetes, there was no significant survival difference at all ages between fistula and graft (20).…”

Section: Discussionmentioning

confidence: 83%

Early Failure of Dialysis Access among the Elderly in the Era of Fistula First

Woo¹,

Goldman

Romley

2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Recent evidence indicates that fistula maturation and patency may be compromised in the elderly dialysis population compared with younger patients. The objective of this study was to characterize the short-term outcomes of arteriovenous fistulas and arteriovenous grafts for hemodialysis access in the Medicare population.Design, setting, participants, & measurements This was a retrospective cohort study performed using Medicare Part A and B claims data from 2006 through 2011. The study population included 16,464 dialysis-dependent patients age $66 years undergoing arteriovenous fistula and arteriovenous graft creation. The primary outcome measure was incidence of repeat fistula/graft creation and tunneled catheter placements in the 12 months after arteriovenous fistula and graft creation.Results In the 12 months postindex fistula/graft, the mortality in the fistula group was 28.2% versus 29.9% in the graft group (P=0.03). A repeat fistula/graft creation was required in 26.9% of patients in the fistula group and 16.7% in the graft group (P,0.001). There was no significant difference in the proportion of patients who required a tunneled hemodialysis catheter in the 12 months after an index fistula creation (fistula 28.4% versus graft 27.3%, P=0.19). In the index fistula group, 44.4% of patients required a repeat fistula/graft creation and/or a tunneled catheter, compared with 33.7% in the graft group (P,0.001). At 365 days after the index fistula/graft, the repeat fistula/graft/catheter-free survival was 39.7% in the fistula group versus 46.0% in the graft group (P,0.001). Index fistula was associated with a higher risk of loss of repeat fistula/graft/catheter-free survival with an odds ratio of 1.19 (95% confidence interval, 1.13 to 1.24).Conclusions Fistulas were associated with a somewhat lower mortality than grafts in the first 12 months after creation. However, the incidence of repeat fistula/graft creation and tunneled catheter placement is substantially higher in the first 12 months after fistula creation compared with grafts. One-year repeat fistula/graft/catheterfree survival is lower after fistula creation than grafts.

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Section: Discussionmentioning

confidence: 83%

Early Failure of Dialysis Access among the Elderly in the Era of Fistula First

Woo¹,

Goldman

Romley

2015

Clinical Journal of the American Society of Nephrology

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“…Drew et al [30], even though promoted AVF first, have developed a decision mode analysis. These investigators concluded that AVFs are superior to arterio-venous grafts and TCC when analyzing mortality and cost in the majority of patients, especially younger men without diabetes.…”

Section: Discussionmentioning

confidence: 99%

Survival and Clinical Outcomes of Tunneled Central Jugular and Femoral Catheters in Prevalent Hemodialysis Patients

Guillermo-Corpus¹,

Ramos-Gordillo²,

Peña-Rodríguez³

2018

Blood Purif

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Background: The literature on the outcomes of tunneled femoral catheters compared to that of jugular catheters is scarce and derived mainly from small cohorts. Material and Methods: Seven hundred and sixty six catheters were placed in 673 hemodialysis patients, 622 in the jugular/subclavian veins and 144 in the femoral veins. Patients were followed prospectively for 36 months. Results: The survival of the tunneled catheters was 771 days 95% CI (737–805) for jugular and 660 days 95% CI (582–739) for femoral veins. Blood flow (0.292 ± 0.003 L/min) and infection rate (0.25 × 1,000 days/catheter) were similar for upper and lower extremities vascular accesses. Factors including sex, age, diabetes and previous catheters did not affect the outcome. Conclusions: Femoral catheters provide outstanding vascular access with excellent, function and low risk of infection.

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“…The establishment and maintenance of an optimal VA in elderly patients is challenging. National clinical guidelines and recommendations are not age specific and do not address the difficulty of VA placement and maintenance in elderly patients despite the marked differences in comorbidities and the natural history of chronic kidney disease in elderly patients compared to non-elderly or young patients [11] . Increased age is generally associated with maturation failure in AVF, and this risk may be more than doubled in the elderly population [12][13][14] .…”

Section: Discussionmentioning

confidence: 99%

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

Park

Kim

et al. 2016

Am J Nephrol

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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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Vascular Access Choice in Incident Hemodialysis Patients

Cited by 121 publications

References 25 publications

Early Failure of Dialysis Access among the Elderly in the Era of Fistula First

Early Failure of Dialysis Access among the Elderly in the Era of Fistula First

Survival and Clinical Outcomes of Tunneled Central Jugular and Femoral Catheters in Prevalent Hemodialysis Patients

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

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