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Am J Kidney Dis. 2014 Mar;63(3):464-78. doi: 10.1053/j.ajkd.2013.08.023. Epub 2013 Oct 30.

Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis.

Author information

1
Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
2
Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
3
Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
4
Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
5
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
6
Department of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
7
Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Electronic address: louise.moist@lhsc.on.ca.

Abstract

BACKGROUND:

Advantages of the arteriovenous fistula (AVF), including long patency and few complications, were ascertained more than 2 decades ago and may not apply to the contemporary dialysis population.

STUDY DESIGN:

Systematic review and meta-analysis. Estimates were pooled using a random-effects model and sources of heterogeneity were explored using metaregression.

SETTING & POPULATION:

Patients treated with long-term hemodialysis using an AVF.

SELECTION CRITERIA FOR STUDIES:

English-language studies indexed in MEDLINE between 2000 and 2012 using prospectively collected data on 100 or more AVFs.

PREDICTOR:

Age, AVF location, and study location.

OUTCOMES:

Outcomes of interest were primary AVF failure and primary and secondary patency at 1 and 2 years.

RESULTS:

7,011 citations were screened and 46 articles met eligibility criteria (62 unique cohorts; n = 12,383). The rate of primary failure was 23% (95% CI, 18%-28%; 37 cohorts; 7,393 AVFs). When primary failures were included, the primary patency rate was 60% (95% CI, 56%-64%; 13 studies; 21 cohorts; 4,111 AVFs) at 1 year and 51% (95% CI, 44%-58%; 7 studies; 12 cohorts; 2,694 AVFs) at 2 years. The secondary patency rate was 71% (95% CI, 64%-78%; 10 studies; 11 cohorts; 3,558 AVFs) at 1 year and 64% (95% CI, 56%-73%; 6 studies; 11 cohorts; 1,939 AVFs) at 2 years. In metaregression, there was a significant decrease in primary patency rate in studies that started recruitment in more recent years.

LIMITATIONS:

Low quality of studies, variable clinical settings, and variable definitions of primary AVF failure.

CONCLUSIONS:

In recent years, AVFs had a high rate of primary failure and low to moderate primary and secondary patency rates. Consideration of these outcomes is required when choosing a patient's preferred access type.

KEYWORDS:

Hemodialysis; epidemiology and outcomes; fistula; patency; primary failure; vascular access

PMID:
24183112
DOI:
10.1053/j.ajkd.2013.08.023
[Indexed for MEDLINE]

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