Author:
Ocak Gürbey,Rotmans Joris I,Vossen Carla Y,Rosendaal Frits R,Krediet Raymond T,Boeschoten Elisabeth W,Dekker Friedo W,Verduijn Marion
Abstract
Abstract
Background
There are only a few risk factors known for primary patency loss in patients with an arteriovenous graft or fistula. Furthermore, a limited number of studies have investigated the association between arteriovenous access modality and primary patency loss and mortality. The aim of this study was to investigate risk factors for patency loss and to investigate the association between graft versus fistula use and outcomes (patency loss and mortality).
Methods
We prospectively followed 919 incident hemodialysis patients and calculated hazard ratios (HRs) for putative risk factors of primary patency loss using Cox regression. Furthermore, HRs were calculated to study the association between graft versus fistula use and two-year primary patency loss and two-year mortality.
Results
Cardiovascular disease, prior catheter use, lowest tertile of albumin, highest tertile of hsCRP, and lowest tertile of fetuin-A were associated with primary patency loss in both patients with grafts and fistulas. Increased age, female sex, and diabetes mellitus were only associated with primary patency loss in patients with a fistula. We did not observe an association between primary patency loss and BMI, residual GFR, levels of calcium, phosphorus, and total cholesterol. Furthermore, graft use as compared with fistula use was associated with an 1.4-fold (95% CI 1.0-1.9) increased risk of primary patency loss and with an 1.5-fold(95% CI 1.0-2.2) increased mortality risk.
Conclusion
Cardiovascular disease, prior catheter use, albumin, hsCRP, and fetuin-A are risk factors for patency loss. Graft use as compared with fistula use was associated with an increased risk of patency loss and mortality.
Publisher
Springer Science and Business Media LLC
Reference31 articles.
1. Feldman HI, Kobrin S, Wasserstein A: Hemodialysis vascular access morbidity. J Am Soc Nephrol. 1996, 7: 523-535.
2. U S Renal Data System: Atlas of Chronic Kidney Disease and End-Stage Renal Disease in the United States, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. 2004, Bethesda, MD: USRDS 2004 Annual Data Report
3. Allon M, Robbin ML: Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions. Kidney Int. 2002, 62: 1109-1124. 10.1111/j.1523-1755.2002.kid551.x.
4. Paszkowiak JJ, Dardik A: Arterial wall shear stress: observations from the bench to the bedside. Vasc Endovascular Surg. 2003, 37: 47-57. 10.1177/153857440303700107.
5. Roy-Chaudhury P, Kelly BS, Miller MA, Reaves A, Armstrong J, Nanayakkara N, Heffelfinger SC: Venous neointimal hyperplasia in polytetrafluoroethylene dialysis grafts. Kidney Int. 2001, 59: 2325-2334.
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