» Articles » PMID: 15788468

Type of Vascular Access and Survival Among Incident Hemodialysis Patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study

Overview
Specialty Nephrology
Date 2005 Mar 25
PMID 15788468
Citations 128
Authors
Affiliations
Soon will be listed here.
Abstract

Arteriovenous fistulae (AVF) have advantages over arteriovenous grafts (AVG) and central venous catheters (CVC), but whether AVF are associated independently with better survival is unclear. Recent studies showing such a survival benefit did not include early access experience or account for changes in access type over time and did not include data on some important confounders. Reported here are survival rates stratified by the type of access in use up to 3 yr after initiation of hemodialysis among 616 incident patients who were enrolled in the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. A total of 1084 accesses (185 AVF, 296 AVG, 603 CVC) were used for a total of 1381 person-years. At initiation, 409 (66%) patients were using a CVC, 122 (20%) were using an AVG, and 85 (14%) were using an AVF. After 6 mo, 34% were using a CVC, 40% were using an AVG, and 26% were using an AVF. Annual mortality rates were 11.7% for AVF, 14.2% for AVG, and 16.1% for CVC. Adjusted relative hazards (RH) of death compared with AVF were 1.5 (95% confidence interval, 1.0 to 2.2) for CVC and 1.2 (0.8 to 1.8) for AVG. The increased hazards associated with CVC, as compared with AVF, were stronger in men (n = 334; RH = 2.0; P = 0.01) than women (n = 282; RH = 1.0 for CVC; P = 0.92). These results strongly support existing clinical practice guidelines and suggest that the use of venous catheters should be minimized to reduce the frequency of access complications and to improve patient survival, especially among male hemodialysis patients.

Citing Articles

Associations between initial dialysis access types and death from dialysis withdrawal in incident patients with kidney failure.

Chen J, Johnson D, Roberts M, Brown M, Brennan F, Wong G Clin Kidney J. 2025; 18(3):sfaf024.

PMID: 40046820 PMC: 11879430. DOI: 10.1093/ckj/sfaf024.


Risk Factors Affecting Mortality in Asian Hemodialysis Patients: A 15-Year Study From Pakistan.

Mahmood S, Hameed N, Naveed H, Qureshi M, Imtiaz S, Rajput A Cureus. 2025; 17(1):e77328.

PMID: 39944431 PMC: 11813641. DOI: 10.7759/cureus.77328.


Vascular Access for Home Hemodialysis: A Perspective on Tunneled Central Venous Catheters at Home.

Aragon M, El Shamy O, Zheng S, Chertow G, Glickman J, Weinhandl E Kidney Med. 2025; 7(1):100916.

PMID: 39803418 PMC: 11721530. DOI: 10.1016/j.xkme.2024.100916.


The Pathological Mechanisms and Therapeutic Molecular Targets in Arteriovenous Fistula Dysfunction.

Yan R, Song A, Zhang C Int J Mol Sci. 2024; 25(17).

PMID: 39273465 PMC: 11395150. DOI: 10.3390/ijms25179519.


Late diagnosis of CKD and associated survival after initiation of renal replacement therapy in Kazakhstan: analysis of nationwide electronic healthcare registry 2014-2019.

Kim V, Zhakhina G, Gusmanov A, Sakko Y, Kim M, Madikenova M Ren Fail. 2024; 46(2):2398182.

PMID: 39229925 PMC: 11376288. DOI: 10.1080/0886022X.2024.2398182.