title: Complications of the Arteriovenous Fistula: A Systematic Review.
abstract: The implementation of patient-centered care requires an individualized approach to hemodialysis vascular access, on the basis of each patient's unique balance of risks and benefits. This systematic review aimed to summarize current literature on fistula risks, including rates of complications, to assist with patient-centered decision making. We searched Medline from 2000 to 2014 for English-language studies with prospectively captured data on ≥100 fistulas. We assessed study quality and extracted data on study design, patient characteristics, and outcomes. After screening 2292 citations, 43 articles met our inclusion criteria (61 unique cohorts;n>11,374 fistulas). Median complication rates per 1000 patient days were as follows: 0.04 aneurysms (14 unique cohorts;n=1827 fistulas), 0.11 infections (16 cohorts;n>6439 fistulas), 0.05 steal events (15 cohorts;n>2543 fistulas), 0.24 thrombotic events (26 cohorts;n=4232 fistulas), and 0.03 venous hypertensive events (1 cohort;n=350 fistulas). Risk of bias was high in many studies and event rates were variable, thus we could not present pooled results. Studies generally did not report variables associated with fistula complications, patient comorbidities, vessel characteristics, surgeon experience, or nursing cannulation skill. Overall, we found marked variability in complication rates, partly due to poor quality studies, significant heterogeneity of study populations, and inconsistent definitions. There is an urgent need to standardize reporting of methods and definitions of vascular access complications in future clinical studies to better inform patient and provider decision making.
authors.affiliation: The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.|Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Al-Jaishi
authors.affiliation: The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.|Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and.
authors.forename: Aiden R
authors.initials: AR
authors.lastname: Liu
authors.affiliation: Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada.
authors.forename: Charmaine E
authors.initials: CE
authors.lastname: Lok
authors.affiliation: The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.|Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and.
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Zhang
authors.affiliation: The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; louise.moist@lhsc.on.ca.|Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and.
authors.forename: Louise M
authors.initials: LM
authors.lastname: Moist
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology*
keywords: arteriovenous fistula; chronic hemodialysis; epidemiology and outcomes