title: Vascular access vulnerability in intensive hemodialysis: a significant Achilles' heel?
abstract: BACKGROUND
  Frequent hemodialysis (HD) may be associated with an increased risk of vascular access complications. Studies addressing vascular access outcomes in frequent HD show conflicting results.
  
  
  METHODS
  We searched Medline for trials looking at vascular access outcomes in frequent HD.
  
  
  RESULTS
  Nineteen studies met the inclusion criteria; only studies with a control group were included for analysis (n = 15). The vascular access event rate was higher in intensive HD as compared to conventional HD (difference of 6.7 events per 100 patient-years, p = 0.009). Overall event rates were not significantly different between conventional and intensive HD when stratified for access type, but were notably higher in the arteriovenous grafts and catheter group as compared to the arteriovenous fistula (AVF) group.
  
  
  CONCLUSIONS
  Intensive HD is associated with an increased risk of vascular access complications. Overall reported event rates were lower in the AVF group. Further controlled studies should investigate whether a 'fistula first' strategy may be recommended also for intensive HD.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: Cornelis
authors.forename: Len A
authors.initials: LA
authors.lastname: Usvyat
authors.forename: Jan H
authors.initials: JH
authors.lastname: Tordoir
authors.forename: Yuedong
authors.initials: Y
authors.lastname: Wang
authors.forename: Michelle
authors.initials: M
authors.lastname: Wong
authors.forename: Karel M
authors.initials: KM
authors.lastname: Leunissen
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
authors.forename: Jeroen P
authors.initials: JP
authors.lastname: Kooman
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012307:Risk Factors; D062666:Vascular Access Devices / Q000009:adverse effects*