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American Journal of Kidney Diseases

Patency Rates of the Arteriovenous Fistula for Hemodialysis: A Systematic Review and Meta-analysis

  • Ahmed A. Al-Jaishi
    Affiliations
    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
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  • Matthew J. Oliver
    Affiliations
    Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Sonia M. Thomas
    Affiliations
    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
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  • Charmaine E. Lok
    Affiliations
    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
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  • Joyce C. Zhang
    Affiliations
    Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada

    Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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  • Amit X. Garg
    Affiliations
    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
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  • Sarah D. Kosa
    Affiliations
    Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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  • Robert R. Quinn
    Affiliations
    Department of Medicine & Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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  • Louise M. Moist
    Correspondence
    Address correspondence to Louise M. Moist, MD, MSc, Medicine & Epidemiology, Schulich School of Medicine, Western University, Kidney Clinical Research Unit, London Health Sciences Centre, Victoria Hospital, 800 Commissioners Rd E, London, Ontario N6A 5W9, Canada.
    Affiliations
    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
    Search for articles by this author
Published:November 01, 2013DOI:https://doi.org/10.1053/j.ajkd.2013.08.023

      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.

      Study Design

      Systematic review and meta-analysis. Estimates were pooled using a random-effects model and sources of heterogeneity were explored using metaregression.

      Setting & Population

      Patients treated with long-term hemodialysis using an AVF.

      Selection Criteria for Studies

      English-language studies indexed in MEDLINE between 2000 and 2012 using prospectively collected data on 100 or more AVFs.

      Predictor

      Age, AVF location, and study location.

      Outcomes

      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.

      Limitations

      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.

      Index Words

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