title: Autogenous versus prosthetic vascular access for hemodialysis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  The autogenous arteriovenous access for chronic hemodialysis is recommended over the prosthetic access because of its longer lifespan. However, more than half of the United States dialysis patients receive a prosthetic access. We conducted a systematic review to summarize the best available evidence comparing the two accesses types in terms of patient-important outcomes.
  
  
  METHODS
  We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and SCOPUS) and included randomized controlled trials and controlled cohort studies. We pooled data for each outcome using a random effects model to estimate the relative risk (RR) and its associated 95% confidence interval (CI). We estimated inconsistency caused by true differences between studies using the I(2) statistic.
  
  
  RESULTS
  Eighty-three studies, of which 80 were nonrandomized, met eligibility criteria. Compared with the prosthetic access, the autogenous access was associated with a significant reduction in the risk of death (RR, 0.76; 95% CI, 0.67-0.86; I(2) = 48%, 27 studies) and access infection (RR, 0.18; 95% CI, 0.11-0.31; I(2) = 93%, 43 studies), and a nonsignificant reduction in the risk of postoperative complications (hematoma, bleeding, pseudoaneurysm and steal syndrome, RR 0.73; 95% CI, 0.48-1.16; I(2) = 65%, 31 studies) and length of hospitalization (pooled weighted mean difference -3.8 days; 95% CI, -7.8 to 0.2; P = .06). The autogenous access also had better primary and secondary patency at 12 and 36 months.
  
  
  CONCLUSIONS
  Low-quality evidence from inconsistent studies with limited protection against bias shows that autogenous access for chronic hemodialysis is superior to prosthetic access.
authors.affiliation: Division of Preventive Medicine, Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minnesota 55905, USA. Murad.Mohammad@mayo.edu
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
authors.forename: Mohamed B
authors.initials: MB
authors.lastname: Elamin
authors.forename: Anton N
authors.initials: AN
authors.lastname: Sidawy
authors.forename: German
authors.initials: G
authors.lastname: Malaga
authors.forename: Adnan Z
authors.initials: AZ
authors.lastname: Rizvi
authors.forename: David N
authors.initials: DN
authors.lastname: Flynn
authors.forename: Edward T
authors.initials: ET
authors.lastname: Casey
authors.forename: Finnian R
authors.initials: FR
authors.lastname: McCausland
authors.forename: Martina M
authors.initials: MM
authors.lastname: McGrath
authors.forename: Danny H
authors.initials: DH
authors.lastname: Vo
authors.forename: Ziad
authors.initials: Z
authors.lastname: El-Zoghby
authors.forename: Audra A
authors.initials: AA
authors.lastname: Duncan
authors.forename: Michal J
authors.initials: MJ
authors.lastname: Tracz
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000295:instrumentation*; D001807:Blood Vessel Prosthesis; D006801:Humans; D006435:Renal Dialysis / Q000379:methods*; D014182:Transplantation, Autologous