Abstract: FR-OR042

A Randomised Controlled Trial of Early Cannulation Grafts (ecAVGs) versus Tunneled Central Venous Catheters in Patients Requiring Urgent Vascular Access for Haemodialysis: One Year Follow-Up Data

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Aitken, Emma L., NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
  • Thomson, Peter C., NHS Greater Glasgow & Clyde, Glasgow, United Kingdom
  • Kingsmore, David, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
Background

Early cannulation arteriovenous grafts (ecAVGs) are proposed as an alternative to tunnelled central venous catheters (TCVCs) in patients requiring immediate vascular access for haemodialysis (HD). We compare bacteraemia rates in patients treated with ecAVG and TCVC. Early follow-up data was recently published in The Journal of Vascular Surgery. One-year follow-up is now presented.

Methods

121 adult patients requiring “urgent” vascular access for HD were randomised in a 1:1 fashion to receive either ecAVG+/-AVF (n=60) or TCVC+/-AVF (n=61). Patients were excluded if they had active systemic sepsis, no anatomically suitable vessels or anticipated life expectancy <3months. The primary end-point was culture-proven bacteraemia rate at 6 months, with the trial powered to detect a reduction in bacteraemia from 24% to 5% (alpha=0.05, beta=0.8). Secondary end points included thrombosis, re-intervention and mortality rates at 6 months and bacteraemia and mortality rates at 12 months (ISRCTN 8058854).

Results

Ten patients in the TCVC+/-AVF arm (16.4%) developed culture-proven bacteraemia within 6 months compared to two (3.3%) in the ecAVG+/-AVF arm (risk ratio 0.2 95% CI 0.12, 0.56; P=0.02). Six-month mortality was also higher in the TCVC+/-AVF cohort (16.4% [n=10] vs. 5% [n=3]; risk ratio 0.3 95% CI 0.08, 0.45; P=0.04). At 1-year follow-up 14 patients (23.3%) in the ecAVG+/-AVF arm and 16 patients (26.2%) in the TCVC+/-AVF arm were dialysing via AVF. Fewer patients in the ecAVG+/-AVF cohort were dialysing via TCVC (18.3% [n=11] vs. 41.0% [n=25]. Eleven patients in the TCVC arm (18.0%) had developed culture-proven bacteraemia at 12 months compared to six (10.0%) in the ecAVG+/-AVF arm (risk ratio 0.55 95% CI 0.24, 0.77; P<0.001). 12-month mortality was also higher in the TCVC+/-AVF cohort (18.0% [n=11] vs. 10.0% [n=6]; risk ratio 0.55 95% CI 0.24, 0.77; P<0.001.

Conclusion

Compared to TCVC+/-AVF, a strategy of ecAVG+/-AVF reduced the rate of culture-proven bacteraemia and mortality in patients requiring urgent vascular access for HD. The previously described early benefits of a strategy of ecAVG+/-AVF have now been demonstrated to persist to at least a year following “urgent” access creation.