Background: Due to the long waiting time for kidney transplantation the majority of End-Stage renal disease patients are commenced on either hemodialysis or peritoneal dialysis. Among all vascular accesses, reusable fistulas have the lowest risk for death, cardiovascular events, and infections. This study aims to report the outcomes of the arteriovenous fistulas and PTFE grafts and the related predictive clinical and demographic variables.
Methods: This retrospective study reviewed the charts of all hemodialysis patients between Jan 2017 and Jan 2021 at the Dialysis Center of An-Najah National University Hospital, Nablus, Palestine. Our outcomes were primary failure, primary and secondary patency and the related factors. Survival analysis using the Kaplan-Meier method was conducted, and the log-rank test was used to compare patency rates. Factors considered relevant to primary and secondary patency rates were tested in univariate and multivariate analyses using the Cox proportional hazards regression model.
Results: A total of 312 procedures were performed during the study period. Primary failure was 7.1% for AVF, 13.9% for AVG procedures. Peripheral arterial disease and left sided AVF were associated with more primary failure rates. AVF, primary patency rate at 1, 2, and 3 years were 82%, 69%, and 59%, respectively, while secondary patency rate at 1, 2, and 3 years were 85%,72% and 63%, respectively. Factors associated with increased AVF patency in a proportional hazard model were younger age and dual antiplatelet administration.
Conclusion: Our study adds further evidence that autogenous AVF has better results than prosthetic AVG in both primary and secondary patency rate as well as less primary failure rates. We encourage further longitudinal studies that assess the benefits of use antiplatelet on AVF outcome versus risks of bleeding especially with dual agents.