Factors associated with the prevalence of arteriovenous fistulas in hemodialysis patients in the HEMO Study

Abstract

Factors associated with the prevalence of arteriovenous fistulasVascular access procedures and their subsequent comin hemodialysis patients in the HEMO Study. plications represent major causes of morbidity, hospital-Background. Arteriovenous (AV) fistulas are the vascular ization, and cost for chronic hemodialysis patients [1-4]. access of choice for hemodialysis patients, but only about 20% Over 20% of hospitalizations in hemodialysis patients of hemodialysis patients in the United States dialyze with fistuin the United States are access related, and the annual las. There is little information known about the factors associated with this low prevalence of fistulas. cost of access morbidity has been estimated at close to Methods. Multiple logistic regression analysis was used to $1 billion [4]. Polytetrafluoroethylene (PTFE) dialysis evaluate the independent contribution of factors associated grafts have decreased longevity as compared with native with AV fistula use among patients enrolled in the HEMO arteriovenous (AV) fistulas [5-8] and are more prone to Study. The analysis was conducted in 1824 patients with fistulas or grafts at 45 dialysis units (15 clinical centers). recurrent stenosis, thrombosis, and infection [9]. Recog-Results. Thirty-four percent of the patients had fistulas. The nizing the superiority of fistulas over grafts, the recently prevalence of fistulas varied markedly from 4 to 77% among published National Kidney Foundation Dialysis Outthe individual dialysis units (P Ͻ 0.001). Multiple regression comes Quality Initiative (DOQI) guidelines on vascular analysis revealed five demographic and clinical factors thataccess [10] recommend an aggressive approach to the were each independently associated with a lower likelihood of having a fistula, even after adjustment for dialysis unit. Specifi-

Comparison of the efficacy of upper arm transposed arteriovenous fistulae and upper arm prosthetic grafts

“…1 Female gender has been repeatedly shown to be a strong predictor of AVG use. 1,20,29,30 Similarly, a number of studies have demonstrated that AVF are used less commonly in African-Americans. 16,29 Increased age 20,29 and presence of diabetes 20 have also been associated with decreased prevalence of fistula use.…”

“…1,20,29,30 Similarly, a number of studies have demonstrated that AVF are used less commonly in African-Americans. 16,29 Increased age 20,29 and presence of diabetes 20 have also been associated with decreased prevalence of fistula use. Furthermore, age, 13,19,31 diabetes, 1,10,32 female gender, 1,33 and history of previous failed dialysis access 7,28,34 have been shown to predict access failure.…”

Factors affecting the patency of arteriovenous fistulas for dialysis access

“…In the Hemodialysis (HEMO) Study, female sex was identified as a significant predictor of graft rather than AVF use, 3 but there is little specific evidence for AVF patency differences between sexes. Women may present with smaller-caliber arteries and may therefore be expected to have lower AVF patency rates than men.…”

Strategies for planning the optimal dialysis access for an individual patient

“…However, when an uncomplicated functional fistula can be quickly achieved to provide prescribed dialysis, then, indeed, it is an ideal access. The finding that AVF rates differ between countries, regions, and even individual centers [33,34] demonstrates that improvement in functional fistula rates is possible. As individual patient characteristics, including age, sex, and comorbidity, as well as vessel size and quality, may influence the chance of fistula failure, preoperative screening and planning may improve the primary maturation rates [35].…”