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Original ArticlesESRD and Chronic Dialysis
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Cumulative Patency of Contemporary Fistulas versus Grafts (2000–2010)

Charmaine E. Lok, Jessica M. Sontrop, George Tomlinson, Dheeraj Rajan, Mark Cattral, George Oreopoulos, Jeremy Harris and Louise Moist
CJASN May 2013, 8 (5) 810-818; DOI: https://doi.org/10.2215/CJN.00730112
Charmaine E. Lok
*Division of Nephrology, Department of Medicine, Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada;
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Jessica M. Sontrop
†Division of Nephrology, Departments of Medicine and Epidemiology & Biostatistics, and
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George Tomlinson
‡Division of General Internal Medicine, Department of Medicine, Toronto General Hospital, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; and
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Dheeraj Rajan
§Division of General Surgery and
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Mark Cattral
§Division of General Surgery and
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George Oreopoulos
‖Division of Vascular Surgery, Department of Surgery, Toronto General Hospital, Toronto, Ontario, Canada
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Jeremy Harris
¶Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada;
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Louise Moist
†Division of Nephrology, Departments of Medicine and Epidemiology & Biostatistics, and
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    Figure 1.

    Survival curves of cumulative patency in hemodialysis patients. (A) 1140 patients: arteriovenous fistulas versus arteriovenous grafts (hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.79–1.23). (B) 714 patients after excluding 426 primary failures: arteriovenous fistulas versus arteriovenous grafts (HR, 0.56; 95% CI, 0.43–0.74).

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    Figure 2.

    Survival curves of cumulative patency in hemodialysis patients with forearm access. (A) 697 patients: arteriovenous fistulas versus arteriovenous grafts (hazard ratio [HR], 0.96; 95% confidence interval [CI], 0.74−1.24; P = 0.64). (B) 425 patients after excluding 272 primary failures: arteriovenous fistulas versus arteriovenous grafts (HR, 0.47; 95% CI, 0.34−0.66; P < 0.001).

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    Figure 3.

    Survival curves of cumulative patency in hemodialysis patients with upper-arm access. (A) 443 patients: arteriovenous fistulas versus arteriovenous grafts (hazard ratio [HR], 1.22; 95% confidence interval [CI], 0.77−1.90; P = 0.37). (B) 289 patients after excluding 154 primary failures: arteriovenous fistulas versus arteriovenous grafts (HR, 0.94; 95% CI, 0.53−1.67; P=0.83).

Tables

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    Table 1.

    Patient characteristics at time of first access creation in 1140 hemodialysis patients

    CharacteristicOverall (n=1140)Dialysis AccessP Valuea
    AV Fistula (n=1012)AV Graft (n=128)
    Mean age (yr)60.0 (18–91)b59.8 (16.4)61.3 (14.9)0.34
    Age ≥ 65 yr513 (45.0)453 (44.8)60 (46.9)0.65
    Male734 (64.4)682 (67.4)52 (40.6)<0.001
    Race
     White823 (72.2)741 (73.2)82 (64.1)0.03
     Black70 (6.1)55 (5.4)16 (12.5)0.002
     Other244 (21.5)214 (21.2)30 (23.4)0.90
    Mean body mass index (kg/m2)27.0 (6.6)26.5 (6.2)30.4 (8.0)<0.0001
    Primary renal diagnosis
     Hypertension230 (20.2)214 (21.1)16 (12.5)0.02
     Diabetes333 (29.2)280 (27.7)53 (41.4)0.001
     GN169 (14.8)151 (14.9)18 (14.1)0.80
     Interstitial nephritis19 (1.7)16 (1.6)3 (2.3)0.53
     Hereditary/other308 (27.0)277 (27.4)31 (24.2)
     Unknown81 (7.1)74 (7.3)7 (5.5)0.44
    Median duration of dialysis at time of access creation (mo) (IQR)0.92 (−3.39 to 5.85)0.92 (−3.68 to 5.56)1.51 (−1.05 to 7.40)0.62
    Comorbid conditions
     Diabetes463 (40.6)390 (38.5)73 (57.0)<0.0001
     Hypertension825 (72.4)727 (71.8)98 (76.6)0.26
     Coronary artery disease274 (24.0)237 (23.4)37 (28.9)0.17
     Congestive heart failure148 (13.0)123 (12.1)25 (19.5)0.02
     Peripheral vascular disease90 (7.9)79 (7.8)11 (8.6)0.76
     Cerebrovascular disease107 (9.4)92 (9.0)15 (11.7)0.33
    • Unless otherwise noted, values are numbers (percentages). Means are given with SDs. AV, arteriovenous; IQR, interquartile range.

    • ↵a Variables were compared using the chi-squared test or t test as appropriate.

    • ↵b Range.

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Clinical Journal of the American Society of Nephrology: 8 (5)
Clinical Journal of the American Society of Nephrology
Vol. 8, Issue 5
May 07, 2013
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Cumulative Patency of Contemporary Fistulas versus Grafts (2000–2010)
Charmaine E. Lok, Jessica M. Sontrop, George Tomlinson, Dheeraj Rajan, Mark Cattral, George Oreopoulos, Jeremy Harris, Louise Moist
CJASN May 2013, 8 (5) 810-818; DOI: 10.2215/CJN.00730112

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Cumulative Patency of Contemporary Fistulas versus Grafts (2000–2010)
Charmaine E. Lok, Jessica M. Sontrop, George Tomlinson, Dheeraj Rajan, Mark Cattral, George Oreopoulos, Jeremy Harris, Louise Moist
CJASN May 2013, 8 (5) 810-818; DOI: 10.2215/CJN.00730112
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Cited By...

  • Patency Outcomes of Arteriovenous Fistulas and Grafts for Hemodialysis Access: A Trade-Off between Nonmaturation and Long-Term Complications
  • The Effect of Risk of Maturation Failure and Access Type on Arteriovenous Access-Related Costs among Hemodialysis Patients
  • Vascular Access for Hemodialysis Patients: New Data Should Guide Decision Making
  • Definitions and End Points for Interventional Studies for Arteriovenous Dialysis Access
  • The Clinical and Economic Effect of Vascular Access Selection in Patients Initiating Hemodialysis with a Catheter
  • Choice of Hemodialysis Access in Older Adults: A Cost-Effectiveness Analysis
  • Reassessing Recommendations for Choice of Vascular Access
  • Complications of the Arteriovenous Fistula: A Systematic Review
  • New Insights into Dialysis Vascular Access: What Is the Optimal Vascular Access Type and Timing of Access Creation in CKD and Dialysis Patients?
  • New Insights into Dialysis Vascular Access: Impact of Preexisting Arterial and Venous Pathology on AVF and AVG Outcomes
  • American Society of Nephrology Quiz and Questionnaire 2015: ESRD/RRT
  • Dialysis Vascular Access Intervention and the Search for Biomarkers
  • Early Failure of Dialysis Access among the Elderly in the Era of Fistula First
  • Embedded Catheters: Minimizing Excessive Embedment Time and Futile Placement while Maintaining Procedure Benefits
  • Vascular Access Creation before Hemodialysis Initiation and Use: A Population-Based Cohort Study
  • Vascular Access Choice in Incident Hemodialysis Patients: A Decision Analysis
  • Alternatives to arteriovenous fistulas
  • The Upfront Risks of Vascular Access Complications
  • Vascular Access for Hemodialysis in Older Adults: A "Patient First" Approach
  • Lifting the Veil: Insights into Vascular Access Options
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