Type of arteriovenous vascular access and association with patency and mortality

BMC Nephrology

Marion Verduijn³  Friedo W Dekker³  Elisabeth W Boeschoten¹  Raymond T Krediet⁴  Frits R Rosendaal⁵  Carla Y Vossen²  Joris I Rotmans⁶  Gürbey Ocak³ 

[1] Hans Mak Institute, Naarden, The Netherlands;Division of Biomedical Genetics, Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands;Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands;Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands;Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands;Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands

关键词: Epidemiology;    Mortality;    Patency;    Graft;    Fistula;    Hemodialysis;   

Others  :  1082959
DOI  :  10.1186/1471-2369-14-79

 received in 2012-10-13, accepted in 2013-03-21,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 Ocak et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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