Abstract: TH-PO761

Long-Term Outcomes of Arteriovenous Fistulas and Grafts in a Large European Cohort

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Voorzaat, Bram M., Leiden University Medical Center, Leiden, Netherlands
  • van der Bogt, Koen E.A., Haaglanden Medisch Centrum, Den Haag, Netherlands
  • Janmaat, Cynthia J., Leiden University Medical Center, Leiden, Netherlands
  • Dekker, Friedo W., Leiden University Medical Center, Leiden, Netherlands
  • Rotmans, Joris I., Leiden University Medical Center, Leiden, Netherlands

Group or Team Name

  • Dutch Vascular Access Study Group
Background

For hemodialysis (HD), arteriovenous fistulas (AVF) are the preferred type of vascular access (VA). Most data on VA durability originate from North America. As practice patterns and patient characteristics differ between Europe and the US, we evaluated outcomes of radiocephalic (RCAVF) and upper arm AVFs and arteriovenous grafts (AVG) in a large retrospective cohort of Dutch HD patients.

Methods

This Dutch Vascular Access Study cohort consists of 1,656 VAs in 1,221 patients in 8 hospitals. To obtain independent observations, only the first matured VA per patient was included. Primary patency started at VA creation and ended at the first intervention or abandonment. Functional patency started at the first cannulation and ended at abandonment. Patency was censored at death or transplant. Patency is presented as median VA survival and analysed using Kaplan-Meier analysis. Hazard ratios for patency loss are calculated using Cox regression analysis using RCAVFs as the reference. Procedure rates are presented per year of functional patency.

Results

863 VAs (420 RCAVF, 341 upper arm AVF, 102 AVG) were analysed. The median primary patency for RCAVFs was 13.8 ± 1.8 months, for upper arm AVFs 26.6 ± 4.5 months and for AVGs 11.4 ± 1.8 months. The hazard ratio for loss of primary patency was higher for AVGs than RCAVFs (HR 1.52, 95% confidence interval: 1.18 – 1.96), and lower for upper arm AVFs (HR 0.74, 0.60 – 0.90). The median of functional patency was not met during the follow-up (fig 1). At 48 months 82% of RCAVFs, 79% of upper arm AVFs and 73% of AVGs were still functionally patent (death-censored). The number of procedures was lowest for RCAVFs (0.8 ± 2.1/year) versus upper arm AVFs (1.4 ± 8.7/year) and AVGs (2.5 ± 5.8/year).

Conclusion

In the Dutch Vascular Access Study cohort, long-term functional patency was comparable between the 3 groups of arteriovenous access configurations. However, the number of procedures required to maintain AVG patency is 3-fold higher compared to RCAVFs.

Death/transplant-censored primary and functional patency

Funding

  • Commercial Support