Cumulative Patency of Contemporary Fistulas versus Grafts (2000-2010)

被引:175
作者
Lok, Charmaine E. [1 ,2 ]
Sontrop, Jessica M. [3 ,4 ]
Tomlinson, George [6 ,7 ]
Rajan, Dheeraj [8 ]
Cattral, Mark [8 ]
Oreopoulos, George [9 ]
Harris, Jeremy [5 ]
Moist, Louise [3 ,4 ]
机构
[1] Toronto Gen Hosp, Dept Med, Div Nephrol, Toronto, ON M5G 2C4, Canada
[2] Univ Toronto, Toronto, ON, Canada
[3] Univ Western Ontario, Dept Med, Div Nephrol, Schulich Sch Med & Dent, London, ON, Canada
[4] Univ Western Ontario, Dept Epidemiol & Biostat, Div Nephrol, Schulich Sch Med & Dent, London, ON, Canada
[5] Univ Western Ontario, Dept Surg, Schulich Sch Med & Dent, London, ON N6A 3K7, Canada
[6] Univ Toronto, Toronto Gen Hosp, Div Gen Internal Med, Dept Med, Toronto, ON M5G 1L7, Canada
[7] Univ Toronto, Dalla Lana Sch Publ Hlth, Toronto, ON, Canada
[8] Toronto Gen Hosp, Div Gen Surg, Dept Surg, Toronto, ON, Canada
[9] Toronto Gen Hosp, Div Vasc Surg, Dept Surg, Toronto, ON, Canada
来源
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2013年 / 8卷 / 05期
关键词
TRANSPOSED BRACHIOBASILIC FISTULAS; INCIDENT HEMODIALYSIS-PATIENTS; QUALITY INITIATIVE GUIDELINES; VASCULAR ACCESS USE; ARTERIOVENOUS-FISTULA; KIDNEY-DISEASE; OUTCOMES; DIALYSIS; 1ST; MATURATION;
D O I
10.2215/CJN.00730112
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background and objectives Comparisons of fistulas and grafts often overlook the high primary failure rate of fistulas. This study compared cumulative patency (time from access creation to permanent failure) of fistulas and grafts. Design, setting, participants, & measurements Vascular accesses of 1140 hemodialysis patients from two centers (Toronto and London, Ontario, Canada, 2000-2010) were analyzed. Cumulative patency was compared between groups using Kaplan-Meier survival curves and log-rank tests. Hazard ratios (HRs) for fistula failure relative to grafts and 95% confidence intervals (95% CIs) are reported. Results There were 1012(88.8%) fistulas and 128(11.2%) grafts. The primary failure rate was two times greater for fistulas than for grafts: 40% versus 19% (P<0.001). Cumulative patency did not differ between fistulas and grafts for the patients' first access (median, 7.4 versus 15.0 months, respectively [HR, 0.99; 95% CI, 0.79-1.23; P=0.85]) or for 600 with a subsequent access (7.0 versus 9.0 months [HR, 0.93; 95% CI, 0.77-1.13; P=0.39]). However, when primary failures were excluded, cumulative patency became significantly longer for fistulas than for grafts for both first and subsequent accesses (61.9 versus 23.8 months [HR, 0.56; 95% CI, 0.43-0.74; P<0.001] and 42.8 versus 15.9 months [HR, 0.56; 95% CI, 0.44-0.72; P<0.001]). Results were similar for forearm and upper-arm accesses. Compared with functioning fistulas, grafts necessitated twice as many angioplasties (1.4 versus 3.2/1000 days, respectively; P<0.001) and significantly more thrombolysis interventions (0.06 versus 0.98/1000 days; P<0.001) to maintain patency once matured and successfully used for dialysis. Conclusions Cumulative patency did not differ between fistulas and grafts; however, grafts necessitated more interventions to maintain functional patency. Clin J Am Soc Nephrol 8: 810-818, 2013. doi: 10.2215/CJN.00730112
引用
收藏
页码:810 / 818
页数:9
相关论文
共 55 条
[1]   Central vein stenosis: A nephrologist's perspective [J].
Agarwal, Anil K. ;
Patel, Bhairavi M. ;
Haddad, Nabil J. .
SEMINARS IN DIALYSIS, 2007, 20 (01) :53-62
[2]   Effect of change in vascular access on patient mortality in hemodialysis patients [J].
Allon, M ;
Daugirdas, J ;
Depner, TA ;
Greene, T ;
Ornt, D ;
Schwab, SJ .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2006, 47 (03) :469-477
[3]  
Allon M, 2004, AM J KIDNEY DIS, V44, P779, DOI 10.1016/S0272-6386(04)01078-9
[4]   Increasing arteriovenous fistulas in hemodialysis patients: Problems and solutions [J].
Allon, M ;
Robbin, ML .
KIDNEY INTERNATIONAL, 2002, 62 (04) :1109-1124
[5]   Effect of preoperative sonographic mapping on vascular access outcomes in hemodialysis patients [J].
Allon, M ;
Lockhart, ME ;
Lilly, RZ ;
Gallichio, MH ;
Young, CT ;
Barker, J ;
Deierhoi, MH ;
Robbin, ML .
KIDNEY INTERNATIONAL, 2001, 60 (05) :2013-2020
[6]   Current management of vascular access [J].
Allon, Michael .
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2007, 2 (04) :786-800
[7]   Fistula First: Recent Progress and Ongoing Challenges [J].
Allon, Michael .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2011, 57 (01) :3-6
[8]   Dialysis Fistula or Graft: The Role for Randomized Clinical Trials [J].
Allon, Michael ;
Lok, Charmaine E. .
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2010, 5 (12) :2348-2354
[9]  
[Anonymous], 2008, Canadian Journal of Diabetes, V32
[10]  
[Anonymous], 2001, AM J KIDNEY DIS, V37, pS137, DOI DOI 10.1016/S0272-6386(01)70007-8