title: Type of arteriovenous vascular access and association with patency and mortality.
abstract: BACKGROUND
  There are only a few risk factors known for primary patency loss in patients with an arteriovenous graft or fistula. Furthermore, a limited number of studies have investigated the association between arteriovenous access modality and primary patency loss and mortality. The aim of this study was to investigate risk factors for patency loss and to investigate the association between graft versus fistula use and outcomes (patency loss and mortality).
  
  
  METHODS
  We prospectively followed 919 incident hemodialysis patients and calculated hazard ratios (HRs) for putative risk factors of primary patency loss using Cox regression. Furthermore, HRs were calculated to study the association between graft versus fistula use and two-year primary patency loss and two-year mortality.
  
  
  RESULTS
  Cardiovascular disease, prior catheter use, lowest tertile of albumin, highest tertile of hsCRP, and lowest tertile of fetuin-A were associated with primary patency loss in both patients with grafts and fistulas. Increased age, female sex, and diabetes mellitus were only associated with primary patency loss in patients with a fistula. We did not observe an association between primary patency loss and BMI, residual GFR, levels of calcium, phosphorus, and total cholesterol. Furthermore, graft use as compared with fistula use was associated with an 1.4-fold (95% CI 1.0-1.9) increased risk of primary patency loss and with an 1.5-fold(95% CI 1.0-2.2) increased mortality risk.
  
  
  CONCLUSIONS
  Cardiovascular disease, prior catheter use, albumin, hsCRP, and fetuin-A are risk factors for patency loss. Graft use as compared with fistula use was associated with an increased risk of patency loss and mortality.
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Gürbey
authors.initials: G
authors.lastname: Ocak
authors.forename: Joris I
authors.initials: JI
authors.lastname: Rotmans
authors.forename: Carla Y
authors.initials: CY
authors.lastname: Vossen
authors.forename: Frits R
authors.initials: FR
authors.lastname: Rosendaal
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Krediet
authors.forename: Elisabeth W
authors.initials: EW
authors.lastname: Boeschoten
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.forename: Marion
authors.initials: M
authors.lastname: Verduijn
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012307:Risk Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology*
references.citation: Nephrol Dial Transplant. 2001 Jun;16(6):1120-9
references.pmid: 11390709
references.citation: J Vasc Surg. 1997 Dec;26(6):1009-19
references.pmid: 9423717
references.citation: Kidney Int. 2005 Jun;67(6):2383-92
references.pmid: 15882283
references.citation: Kidney Int. 2001 Oct;60(4):1443-51
references.pmid: 11576358
references.citation: Nephron Clin Pract. 2010;116(2):c143-7
references.pmid: 20516714
references.citation: Am J Nephrol. 1996;16(2):118-23
references.pmid: 8919227
references.citation: Blood Purif. 2003;21(1):99-110
references.pmid: 12596755
references.citation: Vasc Endovascular Surg. 2003 Jan-Feb;37(1):47-57
references.pmid: 12577139
references.citation: J Am Soc Nephrol. 2005 May;16(5):1449-55
references.pmid: 15788468
references.citation: J Am Soc Nephrol. 1996 Apr;7(4):523-35
references.pmid: 8724885
references.citation: Kidney Int. 2002 Oct;62(4):1109-24
references.pmid: 12234281
references.citation: J Am Soc Nephrol. 1995 Dec;6(6):1613-8
references.pmid: 8749688
references.citation: Kidney Int. 2001 Jun;59(6):2325-34
references.pmid: 11380837
references.citation: Atherosclerosis. 2009 Jan;202(1):2-10
references.pmid: 18951547
references.citation: Clin J Am Soc Nephrol. 2010 Oct;5(10):1787-92
references.pmid: 20576823
references.citation: Nephrol Dial Transplant. 2011 Jul;26(7):2264-70
references.pmid: 21220751
references.citation: Am J Kidney Dis. 2006 Jan;47(1):139-48
references.pmid: 16377395
references.citation: Am J Kidney Dis. 2004 Jan;43(1):74-84
references.pmid: 14712430
references.citation: Ren Fail. 2006;28(4):275-81
references.pmid: 16771241
references.citation: Kidney Int. 2005 Sep;68(3):1312-9
references.pmid: 16105066
references.citation: J Nephrol. 2005 Jan-Feb;18(1):9-20
references.pmid: 15772918
references.citation: Am J Kidney Dis. 2000 Jul;36(1):68-74
references.pmid: 10873874
references.citation: Atherosclerosis. 1988 Aug;72(2-3):135-41
references.pmid: 3063267
references.citation: Clin J Am Soc Nephrol. 2008 May;3(3):714-9
references.pmid: 18256379
references.citation: Clin J Am Soc Nephrol. 2010 Dec;5(12):2348-54
references.pmid: 21030576
references.citation: Lancet. 2003 Mar 8;361(9360):827-33
references.pmid: 12642050
references.citation: Nephrol Dial Transplant. 2011 Aug;26(8):2611-7
references.pmid: 21282302
references.citation: Am J Kidney Dis. 1997 Oct;30(4 Suppl 3):S150-91
references.pmid: 9339150
references.citation: Am J Kidney Dis. 2010 Oct;56(4):720-7
references.pmid: 20801568
references.citation: Kidney Int. 2007 Jul;72(2):202-7
references.pmid: 17342178