Upper Extremity Ischemia/Dialysis Access

Arteriovenous Graft Placement in Predialysis Patients: A Potential Catheter-Sparing Strategy

Shingarev R, Maya ID, Barker-Finkel J, et al (Univ of Alabama at Birmingham; Montana State Univ, Bozeman) Am J Kidney Dis 58:243–247, 2011^§

Abstract

Background

When predialysis patients are deemed unsuitable candidates for an arteriovenous fistula, current guidelines recommend waiting until just before or after initiation of dialysis therapy before placing a graft. This strategy may increase catheter use when these patients start dialysis therapy. We compared the outcomes of patients whose grafts were placed before and after dialysis therapy initiation.

Study Design

Retrospective analysis of a prospective computerized vascular access database.

Setting & Participants

Patients with chronic kidney disease receiving their first arteriovenous graft (n = 248) at a large medical center.

Predictor

Timing of graft placement (before or after initiation of dialysis therapy).

Outcome & Measurements

Primary graft failure, cumulative graft survival, catheter dependence, and catheter-related bacteremia.

Results

The first graft was placed predialysis in 62 patients and postdialysis in 186 patients. Primary graft failure was similar for pre- and postdialysis grafts (20% vs 24%; P = 0.5). Median cumulative graft survival was similar for pre- and postdialysis grafts (365 vs 414 days; HR, 1.22; 95% CI, 0.81-1.98; P = 0.3). Median duration of catheter dependence after graft placement in the postdialysis group was 48 days and was associated with 0.63 (95% CI, 0.48-0.79) episodes of catheter-related bacteremia per patient.

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