Arteriovenous Fistula Use Is Associated with Lower Cardiovascular Mortality Compared with Catheter Use among ESRD Patients

• Type of Material: Article
• Authors: Haimanot Wasse, Emory University; Rebecca A. Speckman, Emory University; William McClellan, Emory University
• Language: English
• Date: 2008
• Publisher: Wiley: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2008 Wiley Periodicals, Inc.
• Final Published Version (URL): http://onlinelibrary.wiley.com/doi/10.1111/j.1525-139X.2008.00467.x/abstract
• Title of Journal or Parent Work: Seminars in Dialysis
• ISSN: 0894-0959
• Volume: 21
• Issue: 5
• Start Page: 483
• End Page: 489
• Grant/Funding Information: This work was supported in part by a National Institutes of Health Career Development Award K23 DK65634 (H.W) and a Robert Wood Johnson Harold Amos Medical Faculty Development Fellowship (H.W.).; National Institute of Diabetes and Digestive and Kidney Diseases : NIDDK
• Research Categories: Health Sciences, Epidemiology

Abstract

The arteriovenous fistula (AVF) is the recommended form of dialysis vascular access, however, limited studies suggest that AVF creation may result in increased cardiovascular stress and remodeling. To explore the contribution of vascular access type to cardiovascular-related (CV) mortality, we analyzed USRDS Clinical Performance Measures data comprising 4854 patients that initiated dialysis between October 1, 1999–December 31, 2004. CV mortality included death from acute myocardial infarction, atherosclerotic heart disease, cardiomyopathy, arrhythmia, cardiac arrest or stroke. Risk of cardiovascular mortality during a 4-year observation was analyzed by Cox-regression methods with adjustments for demographic and co-morbid conditions. AVF use was strongly associated with lower all-cause and CV mortality. After adjustment for covariates, AVF use 90 days after dialysis initiation remained significantly associated with lower cardiovascular mortality [hazard ratio (HR) 0.69, p = 0.0004] compared with catheter use. These findings suggest that vascular access type influences cause-specific mortality beyond that of infection, and support existing guidelines recommending the use of an AVF early in the course of chronic end-stage renal disease therapy.