Factors affecting the lifespan of autologous and synthetic arteriovenous access routes for haemodialysis

Abstract

Objective: To try and establish a consensus about the ideal secondary access for haemodialysis by assessing factors that affect the longevity of various access routes.

Design: Multicentre survey, by questionnaire.

Setting: General hospital, Athens.

Subjects: All 1516 patients in the Athens area receiving chronic haemodialysis.

Main outcome measures: Longevity of present and any previous access routes (n = 2323). Data including type of access, age, sex and the existence of diabetes, hypertension, hyperlipidaemia, or other systematic diseases were recorded.

Results: Some 1220 (80%) of the patients were using autologous access, 1049 (69%) arteriovenous (AV) fistulas at wrist and 171 (11%) at elbow. Variables were analysed using Cox's proportional hazard model. Age and female sex were significantly associated with failure of autogenous access (p < 0.001) although not affecting synthetic grafts. Autogenous fistula at the elbow was the only secondary access that was less likely to fail than the initial (baseline) fistula at the wrist. Among the various grafts, straight arm grafts had the best prognosis and straight forearm grafts were the most likely to fail (p < 0.001).

Conclusion: An AV fistula at the elbow should be considered the second best after the fistula at wrist, but is not always feasible. A synthetic graft is more likely to be needed in elderly patients and women, in whom an autogenous AV fistula is more likely to fail.