Restricted accessReview articleFirst published online 2022-12
Impact of arteriovenous fistulas versus arteriovenous grafts on vascular access performance in haemodialysis patients: A systematic review and meta-analysis
Controversy exists regarding the best-performing vascular access type for patients undergoing haemodialysis. We aimed to compare outcomes of starting dialysis on arteriovenous fistulas (AVFs) versus arteriovenous grafts (AVGs) in haemodialysis patients.
Methods
We conducted a systematic search of multiple electronic information sources and bibliographic reference lists. The following outcome parameters were evaluated at 1, 2 and 5 years: primary failure, defined as access never used for dialysis; primary patency, defined as intervention-free access survival; primary-assisted patency, defined as uninterrupted access survival with interventions; and secondary patency, defined as cumulative access survival.
Results
We identified 15 comparative studies reporting a total of 118,434 patients who initiated haemodialysis with AVF (n = 95,143) or AVG (n = 23,291). Our analysis demonstrated that AVF was associated with significantly higher primary failure rate (OR: 2.05, p = .0005) but significantly higher rate of primary patency at 1 year (OR: 1.91, p < .00001), at 2 years (OR: 2.52, p < .00001) and at 5 years (OR: 2.59, p < .00001); and primary-assisted patency at 1 year (OR: 1.71, p < .00001), at 2 years (OR: 2.13, p < .00001) and 5 years (OR: 2.79, p < .00001). There was no significant difference in secondary patency at 1 year (OR: 1.08, p < .00001) but AVF had better secondary patency at 2 years (OR: 1.26, p < .00001) and 5 years (OR: 1.60, p < .00001) than AVG.
Conclusions
The meta-analysis of best available comparative evidence (Level 2) demonstrated that AVFs may be associated with significantly higher primary failure rate but higher primary patency, primary-assisted patency and secondary patency at 1, 2 and 5 years compared to AVGs. However, the available evidence is subject to significant selection bias and confounding by indication.
BresciaMJCiminoJEAppelK, et al.Chronic hemodialysis using venipuncture and a surgically created arteriovenous fistula. N Engl J Med1966; 275(20): 1089–1092.
2.
ViecelliAKTongAO'LoneE, et al.Report of the standardized outcomes in nephrology-hemodialysis (SONG-HD) consensus workshop on establishing a core outcome measure for hemodialysis vascular access. Am J kidney Dis2018; 71(5): 690–700.
3.
WilminkT. Vascular access: clinical practice guidelines of the european society for vascular surgery. Eur J Vasc Endovasc Surg2018; 55(6): 753–754.
4.
SchmidliJWidmerMKBasileC, et al.Editor’s choice - vascular access: 2018 clinical practice guidelines of the european society for vascular surgery (ESVS). Eur J Vasc Endovasc Surg2018; 55(6): 757–818.
5.
TordoirJCanaudBHaageP, et al.EBPG on vascular access. Nephrol Dial Transplant2007; 22(Suppl 2): ii88–117.
6.
NKF/KDOQI. 2006 Update vascular access. Guideline 2: selection and placement of hemodialysis access. Am J Kidney Dis2006; 48(Suppl 1): S183–S247.
7.
DrewDALokCECohenJT, et al.Vascular access choice in incident hemodialysis patients: a decision analysis. J Am Soc Nephrol2015; 26(1): 183–191.
8.
WishJB. Catheter last, fistula not-so-first. J Am Soc Nephrol2015; 26(1): 5–7.
9.
BesarabA. Resolved: fistulas are preferred to grafts as initial vascular access for dialysis. J Am Soc Nephrol2008; 19(9): 1629–1633.
10.
SantoroDBenedettoFMondelloP, et al.Vascular access for hemodialysis: current perspectives. Int J Nephrol Renovascular Dis2014; 7: 281–294.
11.
MoistLMLokCEVachharajaniTJ, et al.Optimal hemodialysis vascular access in the elderly patient. Semin Dial2012; 25(6): 640–648.
12.
GomesASchmidtRWishJ. Re-envisioning fistula first in a patient-centered culture. Clin J Am Soc Nephrol2013; 8(10): 1791–1797.
13.
PisoniRLArringtonCJAlbertJM, et al.Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis2009; 53(3): 475–491.
14.
PolkinghorneKRMcDonaldSPAtkinsRC, et al.Vascular access and all-cause mortality: a propensity score analysis. J Am Soc Nephrol2004; 15(2): 477–486.
15.
PisoniRLZepelLPortFK, et al.Trends in US vascular access use, patient preferences, and related practices: an update from the US DOPPS practice monitor with international comparisons. Am J Kidney Dis2015; 65(6): 905–915.
16.
FluckRPitcherDSteenkampR. Vascular access audit report 2012. Care UrraNK. NHS Information Centre, 2012.
17.
PisoniRLZepelLFluckR, et al.International differences in the location and use of arteriovenous accesses created for hemodialysis: results from the dialysis outcomes and practice patterns study (DOPPS). Am J Kidney Dis2018; 71(4): 469–478.
18.
ViecelliAKO’LoneESautenetB, et al.Vascular access outcomes reported in maintenance hemodialysis trials: a systematic review. Am J Kidney Dis2018; 71(3): 382–391.
19.
LiberatiAAltmanDGTetzlaffJ, et al.The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ2009; 339: b2700.
KalmanPGPopeMBholaC, et al.A practical approach to vascular access for hemodialysis and predictors of success. J Vasc Surg1999; 30(4): 727–733. DOI: 10.1016/s0741-5214(99)70112-6.
23.
AscherEGadePHingoraniA, et al.Changes in the practice of angioaccess surgery: impact of dialysis outcome and quality initiative recommendations. J Vasc Surg2000; 31(1 Pt 1): 84–92. DOI: 10.1016/s0741-5214(00)70070-x.
24.
OliverMJMcCannRLIndridasonOS, et al.Comparison of transposed brachiobasilic fistulas to upper arm grafts and brachiocephalic fistulas. Kidney Int2001; 60(4): 1532–1539. DOI: 10.1046/j.1523-1755.2001.00956.x.
25.
GibsonKDGillenDLCapsMT, et al.Vascular access survival and incidence of revisions: a comparison of prosthetic grafts, simple autogenous fistulas, and venous transposition fistulas from the United States resnal data system dialysis morbidity and mortality study. J Vasc Surg2001; 34(4): 694–700. DOI: 10.1067/mva.2001.117890.
26.
PfledererTAKwokSKetelBL, et al.A comparison of transposed brachiobasilic fistulae with nontransposed fistulae and grafts in the Fistula First era. Semin Dial2008; 21(4): 357–363. DOI: 10.1111/j.1525-139X.2008.00451.x.
27.
SnyderDCClericuzioCPStringerA, et al.Comparison of outcomes of arteriovenous grafts and fistulas at a single Veterans’ Affairs medical center. Am J Surg2008; 196(5): 641–646. DOI: 10.1016/j.amjsurg.2008.07.013.
28.
MayaIDO’NealJCYoungCJ, et al.Outcomes of brachiocephalic fistulas, transposed brachiobasilic fistulas, and upper arm grafts. Clin J Am Soc Nephrol2009; 4(1): 86–92. DOI: 10.2215/CJN.02910608.
29.
KimDSKimSWKimJC, et al.Clinical analysis of hemodialysis vascular access: comparision of autogenous arterioveonus fistula & arteriovenous prosthetic graft. Korean J Thorac Cardiovasc Surg2011; 44(1): 25–31. DOI: 10.5090/kjtcs.2011.44.1.25.
30.
HarmsJCRangarajanSYoungCJ, et al.Outcomes of arteriovenous fistulas and grafts with or without intervention before successful use. J Vasc Surg2016; 64(1): 155–162. DOI: 10.1016/j.jvs.2016.02.033.
31.
MarquesGSadaghianlooNFouilhéL, et al.Higher patency of transposed brachio-basilic arteriovenous fistulas compared to brachio-axillary grafts for hemodialysis patients. J Vasc Access2015; 16(6): 486–492. DOI: 10.5301/jva.5000433.
32.
CuiJSteeleDWengerJ, et al.Hemodialysis arteriovenous fistula as first option not necessary in elderly patients. J Vasc Surg2016; 63(5): 1326–1332. DOI: 10.1016/j.jvs.2015.11.036.
33.
PhamXBDKimJJIhenachorEJ, et al.A comparison of brachial artery-brachial vein arteriovenous fistulas with arteriovenous grafts in patients with poor superficial venous anatomy. J Vasc Surg2017; 65(2): 444–451. DOI: 10.1016/j.jvs.2016.09.037.
34.
JadlowiecCCMannionEMLavalleeM, et al.Hemodialysis access in the elderly: outcomes among patients older than seventy. Ann Vasc Surg2016; 31: 77–84. DOI: 10.1016/j.avsg.2015.08.013.
35.
ArhuideseIJOrandiBJNejimB, et al.Utilization, patency, and complications associated with vascular access for hemodialysis in the United States. J Vasc Surg2018; 68(4): 1166–1174. DOI: 10.1016/j.jvs.2018.01.049.
36.
ArhuideseIJCooperMARizwanM, et al.Vascular access for hemodialysis in the elderly. J Vasc Surg2019; 69(2): 517–525el. DOI: 10.1016/j.jvs.2018.05.219.
37.
Al-JaishiAAOliverMJThomasSM, et al.Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis2014; 63(3): 464–478. DOI: 10.1053/j.ajkd.2013.08.023.
38.
AlmasriJAlsawasMMainouM, et al.Outcomes of vascular access for hemodialysis: a systematic review and meta-analysis. J Vasc Surg2016; 64(1): 236–243. DOI: 10.1016/j.jvs.2016.01.053.
