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Kidney Week

Abstract: PO2632

A Pilot Trial of Fistula vs. Graft Access Strategy in Older Adults on Hemodialysis

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Murea, Mariana, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Robinson, Todd W., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Moossavi, Shahriar, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
  • Russell, Gregory B., Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
Background

It is unclear whether surgical placement of an AVF confers significant clinical benefits over an AVG in older adults with ESKD.

Methods

In this pilot randomized, parallel-group, open-label trial, patients ≥65 years old with ESKD, no prior AV access, on HD via a tunneled central venous catheter (CVC), referred for AV access placement by their nephrologist, were randomly assigned (1:1) to surgical placement of AVG or AVF.

Results

Of 122 older adults on HD with no prior AV access, 24% expired before or were too sick for surgery referral. Of 46 eligible patients, 36 consented and randomized to AVG (n=18) and AVF (n=18) placement; 13 (72%) and 16 (89%) underwent index AV access placement, respectively (Figure 1). At median follow-up of 321.0 days, primary AV access failure was noted in 31% in each group. Successful cannulation occurred in 8 (62%) in AVG and 8 (50%) in AVF group; median time to successful cannulation was 75.0 and 113.5 days, respectively. Endovascular procedures were recorded in 38% and 44%, and surgical re-interventions in 23% and 25% (Table 1). AV access infection was seen in 23% and 13% patients, respectively.

Conclusion

Based on these limited results, there is little reason to favor either AVF or AVG in this population until results from a larger randomized clinical trial become available.

Table 1. Vascular Access Outcomes in Patients who Underwent the Assigned AV Access Placement Surgery

Outcome
All
(n= 29)
AVG-first
(n= 13)
AVF-first
(n= 16)
Primary, early AV access failure, n (%)6 (21)4 (31)1 (6)
Time to early AV access failure, median (range), days57.0 (22.0-85.0)47.5 (22.0-79.0)85.0 (-)
Primary, late AV access failure, n (%)3 (10)04 (25)
Time to late AV access failure, median (range), days128.0 (120.0-244.0)--128.0 (120.0-244.0)
First AV access cannulation, n (%)21 (72)10 (77)11 (69)
Time to first AV access cannulation, median (1st, 3rd Quartile), days51.5 (36.0, 66.0)39.5 (35.0, 55.0)63.5 (45.8, 75.0)
Successful AV access cannulation, n (%)16 (55)8 (62)8 (50)
Time to successful AV access cannulation, median (1st, 3rd Quartile), days95.0 (66.5, 151.0)75.0 (53.3, 108.0)113.5 (89.0, 181.5)
Endovascular procedures on index AV access, n (%); #11 (38); 165 (38); 77 (44); 9
Surgical re-intervention on index AV access, n (%); #7 (24); 93 (23); 34 (25); 5
Follow-up from index AV access placement, median (1st, 3rd Quartile), days321.0 (181.0, 365.0)327.0 (202.0, 365.0)321.0 (168.5, 365.0)

Funding

  • Other NIH Support