title: Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Advantages of the arteriovenous fistula (AVF), including long patency and few complications, were ascertained more than 2 decades ago and may not apply to the contemporary dialysis population.
  
  
  METHODS
  Systematic review and meta-analysis. Estimates were pooled using a random-effects model and sources of heterogeneity were explored using metaregression.
  
  
  METHODS
  Patients treated with long-term hemodialysis using an AVF.
  
  
  METHODS
  English-language studies indexed in MEDLINE between 2000 and 2012 using prospectively collected data on 100 or more AVFs.
  
  
  METHODS
  Age, AVF location, and study location.
  
  
  RESULTS
  Outcomes of interest were primary AVF failure and primary and secondary patency at 1 and 2 years.
  
  
  RESULTS
  7,011 citations were screened and 46 articles met eligibility criteria (62 unique cohorts; n = 12,383). The rate of primary failure was 23% (95% CI, 18%-28%; 37 cohorts; 7,393 AVFs). When primary failures were included, the primary patency rate was 60% (95% CI, 56%-64%; 13 studies; 21 cohorts; 4,111 AVFs) at 1 year and 51% (95% CI, 44%-58%; 7 studies; 12 cohorts; 2,694 AVFs) at 2 years. The secondary patency rate was 71% (95% CI, 64%-78%; 10 studies; 11 cohorts; 3,558 AVFs) at 1 year and 64% (95% CI, 56%-73%; 6 studies; 11 cohorts; 1,939 AVFs) at 2 years. In metaregression, there was a significant decrease in primary patency rate in studies that started recruitment in more recent years.
  
  
  CONCLUSIONS
  Low quality of studies, variable clinical settings, and variable definitions of primary AVF failure.
  
  
  CONCLUSIONS
  In recent years, AVFs had a high rate of primary failure and low to moderate primary and secondary patency rates. Consideration of these outcomes is required when choosing a patient's preferred access type.
authors.affiliation: Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Al-Jaishi
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Oliver
authors.affiliation: Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Sonia M
authors.initials: SM
authors.lastname: Thomas
authors.affiliation: Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Charmaine E
authors.initials: CE
authors.lastname: Lok
authors.affiliation: Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Zhang
authors.affiliation: Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sarah D
authors.initials: SD
authors.lastname: Kosa
authors.affiliation: Department of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Quinn
authors.affiliation: Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada. Electronic address: louise.moist@lhsc.on.ca.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Moist
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000592:standards*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D006435:Renal Dialysis / Q000379:methods*; D012307:Risk Factors; D014654:Vascular Patency
keywords: Hemodialysis; epidemiology and outcomes; fistula; patency; primary failure; vascular access