title: The outcome of the primary vascular access and its translation into prevalent access use rates in chronic haemodialysis patients.
abstract: BACKGROUND
  The American Fistula First Breakthrough Initiative currently aims for a 66% arterio-venous fistula (AVF) rate, while in the UK, best practice tariffs target AVF and arterio-venous graft (AVG) rates of 85%. The present study aims to assess whether these goals can be achieved.
  
  
  METHODS
  We conducted a retrospective cohort study on patients who initiated haemodialysis from 1995 to 2006. Outcomes were the final failure-free survival of the first permanent access and the type of second access created. Prevalent use rates for the access types were calculated on the 1st January of each year for the second half of the study period.
  
  
  RESULTS
  Two hundred and eleven out of 246 patients (86%) received an AVF, 16 (6%) an AVG and 19 (8%) a permanent catheter (PC) as the first permanent access. Eighty-six (35%) patients had final failure of the primary access. One- and 3-year final failure-free survival rates were 73 and 65% for AVF compared with 40 and 20% for AVG and 62 and 0% for PC, respectively. In patients with primary AVF, female sex {hazard ratio (HR) 2.20 [confidence interval (CI) 1.29-3.73]} and vascular disease [HR 2.24 (CI 1.26-3.97)] were associated with a poorer outcome. A similar trend was observed for autoimmune disease [HR 2.14 (CI 0.99-4.65)]. As second accesses AVF, AVG and PC were created in 47% (n = 40), 38% (n = 33) and 15% (n = 13). The median prevalent use rate was 80.5% for AVF, 14% for AVG and 5.5% for PC.
  
  
  CONCLUSIONS
  The vascular access targets set by initiatives from the USA and UK are feasible in unselected haemodialysis patients. High primary AVF rates, the superior survival rates of AVFs even in patient groups at higher risk of access failure and the high rate of creation of secondary AVFs contributed to these promising results.
authors: Medical Outpatient Department , University Hospital Basel , Basel , Switzerland.
authors: Claudia
authors: C
authors: Praehauser
authors: Clinic for Transplantation Immunology and Nephrology , University Hospital Basel , Basel , Switzerland.
authors: Tobias
authors: T
authors: Breidthardt
authors: Clinic for Transplantation Immunology and Nephrology , University Hospital Basel , Basel , Switzerland.
authors: Cora Nina
authors: CN
authors: Moser-Bucher
authors: Clinic for Vascular and Transplantation Surgery , University Hospital Basel , Basel , Switzerland.
authors: Thomas
authors: T
authors: Wolff
authors: Clinic for Transplantation Immunology and Nephrology , University Hospital Basel , Basel , Switzerland ; Division of Nephrology , Kantonsspital Luzern , Luzern , Switzerland.
authors: Katrin
authors: K
authors: Baechler
authors: Clinic for Vascular and Transplantation Surgery , University Hospital Basel , Basel , Switzerland.
authors: Thomas
authors: T
authors: Eugster
authors: Clinic for Transplantation Immunology and Nephrology , University Hospital Basel , Basel , Switzerland.
authors: Michael
authors: M
authors: Dickenmann
authors: Clinic for Vascular and Transplantation Surgery , University Hospital Basel , Basel , Switzerland.
authors: Lorenz
authors: L
authors: Gurke
authors: Medical Outpatient Department , University Hospital Basel , Basel , Switzerland ; Clinic for Transplantation Immunology and Nephrology , University Hospital Basel , Basel , Switzerland.
authors: Michael
authors: M
authors: Mayr
keywords: arterio-venous fistula; arterio-venous graft; chronic haemodialysis; incidence and prevalence; vascular access