TY - JOUR
T1 - Stable incidence and survival of arteriovenous fistulas over 39 years
T2 - A long-term national cohort study
AU - Lindhard, Kristine
AU - Hansen, Ditte
AU - Lindegaard Pedersen, Brian
AU - Rix, Marianne
AU - Hansen, Henrik Post
AU - Jensen, Boye L.
AU - Heaf, James
N1 - Publisher Copyright:
© The Author(s) 2021.
PY - 2023
Y1 - 2023
N2 - Introduction: The age and number of comorbidities in the hemodialysis population has increased over time. This may influence the construction and survival of the arteriovenous fistula (AVF). The present study explored the incidence and survival of AVFs over a period of 39 years. Methods: A retrospective cohort study was conducted based on Danish registries. Incident hemodialysis patients between 1977 and 2015 were included. The incidence of AVF and factors associated with the construction of an AVF were described. Risk factors for AVF survival and repair were explored by Kaplan Meier and Cox proportional hazard analysis. Results: The total number of arteriovenous accesses (AVF and arteriovenous grafts) were 10,187 and there were 4201 central venous catheters (CVC). No significant difference in the proportion of AVFs during the 39 years was seen. Age and renal diagnosis did not influence the proportion of AVFs. Patients with CVCs were found to have a significantly higher prevalence of comorbidities (p < 0.01). AVF survival remained stable during the 39 years. The first constructed AVF had the best survival, 35% still functioning after 15 years. Factors such as brachiocephalic AVF, female sex, and diabetic nephropathy increased the risk of AVF failure (Odds Ratio (OR): 2.46, 95% Confidence Interval (CI) (2.29–2.65), 1.17 (1.10–1.25), and 1.21 (1.12–1.3)), respectively. Conclusion: Despite an older dialysis population, the proportion and survival of the AVF in the Danish dialysis population has not changed, probably because of increased awareness of AVF as the first choice of vascular access and improved surveillance, surgery, and repair.
AB - Introduction: The age and number of comorbidities in the hemodialysis population has increased over time. This may influence the construction and survival of the arteriovenous fistula (AVF). The present study explored the incidence and survival of AVFs over a period of 39 years. Methods: A retrospective cohort study was conducted based on Danish registries. Incident hemodialysis patients between 1977 and 2015 were included. The incidence of AVF and factors associated with the construction of an AVF were described. Risk factors for AVF survival and repair were explored by Kaplan Meier and Cox proportional hazard analysis. Results: The total number of arteriovenous accesses (AVF and arteriovenous grafts) were 10,187 and there were 4201 central venous catheters (CVC). No significant difference in the proportion of AVFs during the 39 years was seen. Age and renal diagnosis did not influence the proportion of AVFs. Patients with CVCs were found to have a significantly higher prevalence of comorbidities (p < 0.01). AVF survival remained stable during the 39 years. The first constructed AVF had the best survival, 35% still functioning after 15 years. Factors such as brachiocephalic AVF, female sex, and diabetic nephropathy increased the risk of AVF failure (Odds Ratio (OR): 2.46, 95% Confidence Interval (CI) (2.29–2.65), 1.17 (1.10–1.25), and 1.21 (1.12–1.3)), respectively. Conclusion: Despite an older dialysis population, the proportion and survival of the AVF in the Danish dialysis population has not changed, probably because of increased awareness of AVF as the first choice of vascular access and improved surveillance, surgery, and repair.
KW - arteriovenous fistula
KW - AV access
KW - failure
KW - Hemodialysis
KW - incidence
U2 - 10.1177/11297298211046102
DO - 10.1177/11297298211046102
M3 - Journal article
C2 - 34521278
AN - SCOPUS:85115006503
VL - 24
SP - 620
EP - 629
JO - Journal of Vascular Access
JF - Journal of Vascular Access
SN - 1129-7298
IS - 4
ER -