The effect of comorbid conditions on hemodialysis access patency

Vascular access complications are a continuing source of hospitalization and morbidity in chronic dialysis patients. Several factors have been identified that are associated with complications in patients with native vein and prosthetic bridge arteriovenous graft fistulas. Early failure of native vein arteriovenous fistulas most consistently are related to small blood vessels. It remains unclear whether other comorbid factors play a role in complications of this fistula type. Prosthetic bridge fistulas are frequently placed in the United States and are associated with frequent complications. Factors most consistently associated with higher complication rates are diabetes mellitus, older age, and black race. Antiphospholipid antibody-associated syndromes and erythropoietin therapy have also been suggested as contributing factors. In addition, elevated lipoprotein(a) and hypoalbuminemia have been found to be associated with an increase of prosthetic graft thrombosis in white and Hispanic dialysis patients. This information strongly suggests that fistula complications are multifactorial. An improved understanding of the mechanisms of these associations may aid in the delineation of the pathogenesis and an improvement in the outcome of this important problem.