MP661ARTERIOVENOUS FISTULA AND ARTERIOVENOUS GRAFT FOR VASCULAR ACCESS IN HAEMODIALYSIS - A RETROSPECTIVE COHORT STUDY

Abstract

Background: Arteriovenous fistulas (AVFs) are widely accepted as the preferred haemodialysis vascular access type. However, poor vessel quality and limited life expectancy in the elderly may make AVFs less ideal than AVG in haemodialysis (HD). The goal of this study was to compare survival outcomes in patients with AVF and AVG at dialysis initiation. The primary outcome was all-cause mortality. Material(s) and Method(s): A retrospective observational study of HD's incident patients between 1 January 2010 and 31 December 2014 was conducted. Patients were classified into groups by the vascular access at dialysis initiation. The major comorbidities were evaluated and related with the proposed outcome. Result(s): In this total incident population (n = 138), 108 started HD with an AVF and 30 with an AVG. Nineteen patients died in an average period of 13.3 +/- 9.3 months. The population starting HD with an AVG was older (p = 0.003), more diabetic (p = 0.03), with more comorbidity such as dementia (p<0.001) and cancer (p<0.001) and with lower phosphorus and albumin levels (p<0.001 and p = 0.001, respectively). Compared with the group starting HD with an AVF, a Cox model showed an incremental increase in mortality associated with AVG [(HR) 1.68 (CI: 0.52-3.43), p = 0.032]. Independent factors (p<0.05) associated with mortality in the multivariable Cox model for AVG were: Age (>65 years) [(HR) 4.3 (CI: 0.2-7.9)], diabetes [(HR) 1.5 (CI: 0.2-13.1)], dementia [(HR) 1.5 (CI: 0.5-10.0)], lower albumin levels (<3.5 g/dL) [(HR) 2.1 (CI: 1.3- 4.9)] and ischemic heart disease [(HR) 1.3 (CI: 0.8-3.4)]. Male gender also had a statistically significant result, although it showed a reduced risk of mortality [(HR) 0.048 (CI: 0.023-0.86)]. However, analyzing specific populations, we found that diabetic patients, women and older patients had no incremental increase in mortality associated with an AVG. Conclusion(s): AVG showed an increased mortality risk in older patients with diabetes, dementia, low albumin levels and ischemic heart disease. However, despite recommendations that promote AVF first, the AVG can be a good vascular access especially in diabetic, women and older patients.