title: Increased risk of infection associated with polyurethane dialysis grafts.
abstract: Conventional polytetrafluoroethylene (PTFE) dialysis grafts cannot be cannulated for 2-3 weeks following their creation. Polyurethane grafts, made of a self-sealing material, can be cannulated within 24 hours of implantation, representing a potential advantage in patients with limited catheter options. However, early cannulation may increase the risk of graft infection. We retrospectively queried a prospective, computerized access database to identify 31 patients receiving a polyurethane graft, and 56 date-matched controls with a PTFE graft. Survival techniques were used to plot graft survival. Thrombosis-free graft survival (from creation to first thrombosis or failure) was similar for polyurethane and PTFE grafts (1-year survival, 28%, vs. 32%, p = 0.98). Cumulative graft survival (from creation to permanent failure) was also similar (1-year survival 42% vs. 52%, p = 0.40). Finally, the cumulative risk of graft infection was 37.5% for polyurethane thigh grafts, 23% for polyurethane upper extremity grafts, 21% for PTFE thigh grafts, and 5% for PTFE upper extremity grafts (p = 0.06 for polyurethane vs. PTFE grafts). The likelihood of thrombosis and failure is similar for polyurethane and PTFE grafts. However, polyurethane grafts may have a higher risk of infection, particularly when they are placed in the thigh. In patients with an access emergency, implantation of a polyurethane graft incurs a tradeoff between earlier cannulation and a higher risk of infection.
authors.affiliation: Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Ivan D
authors.initials: ID
authors.lastname: Maya
authors.forename: Janice
authors.initials: J
authors.lastname: Weatherspoon
authors.forename: Carlton J
authors.initials: CJ
authors.lastname: Young
authors.forename: Jill
authors.initials: J
authors.lastname: Barker
authors.forename: Michael
authors.initials: M
authors.lastname: Allon
mesh_terms: D000328:Adult; D000368:Aged; D001672:Biocompatible Materials; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D011140:Polyurethanes; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012307:Risk Factors; D014654:Vascular Patency
chemical_list: D001672:Biocompatible Materials; D011140:Polyurethanes; D011138:Polytetrafluoroethylene