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Related Experiment Videos

Vascular access and all-cause mortality: a propensity score analysis.

Kevan R Polkinghorne1, Stephen P McDonald, Robert C Atkins

  • 1Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia. kevan.polkinghorne@med.monash.edu.au

Journal of the American Society of Nephrology : JASN
|January 30, 2004
PubMed
Summary

Arteriovenous fistula (AVF) use is linked to better survival in hemodialysis patients. Both arteriovenous grafts (AVG) and catheters increase mortality risk, highlighting the importance of AVF for patient outcomes.

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Area of Science:

  • Nephrology
  • Vascular Surgery
  • Epidemiology

Background:

  • Native arteriovenous fistula (AVF) is preferred for hemodialysis due to longevity and lower complication rates.
  • Observational studies suggest AVF may improve survival, but are prone to bias.
  • Propensity score analysis can mitigate bias in non-randomized studies.

Purpose of the Study:

  • To evaluate the impact of vascular access type on total mortality in incident hemodialysis patients.
  • To reduce bias in comparing AVF, arteriovenous grafts (AVG), and catheters using propensity scores.

Main Methods:

  • Study included adult patients starting hemodialysis in Australia and New Zealand (1999-2002) using ANZDATA Registry data.
  • Cox regression and propensity score methods (controlling variable and matched cohorts) were used.

Related Experiment Videos

  • Catheter analysis was stratified by dialysis duration to meet proportional-hazard assumptions.

    • Main Results:

    • Catheter use was independently predictive of mortality after adjusting for confounders and propensity scores.
    • Arteriovenous grafts (AVG) were also associated with a significantly increased risk of death.
    • Findings were consistent in propensity score-matched cohorts, confirming excess mortality with AVG and catheters.

    Conclusions:

    • Both AVG and catheter use in incident hemodialysis patients are associated with significantly higher total mortality.
    • Reducing catheter use and increasing AVF use at hemodialysis initiation are crucial clinical goals.