Theodore H. Yuo, Rabih Chaer, Ellen D. Dillavou, Luke K. Marone, Michel S. Makaroun
Surgery, University of Pittsburgh, Pittsburgh, PA.
OBJECTIVES: SVS guidelines suggest AVF is associated with a survival advantage over AVG. However, AVF often require months to become functional, increasing TDC use in patients starting HD with TDC. We sought to compare survival in ESRD patients based on HD access type.
METHODS: Using U.S. Renal Data System (USRDS) databases, we identified incident HD patients in 2005 and followed them through 2008. Initial access type was assessed using USRDS data collection forms. Attempts at AVF and AVG creation were identified by CPT codes. Patients were divided into groups based on whether an attempt at AVF or AVG was undertaken within 3 months after initiation of HD. Log-rank tests were used for pairwise survival comparisons, stratified by age. The primary outcome was vital status.
RESULTS: We analyzed 46,672 patients who started HD in 2005 and survived at least 3 months. TDC was the initial access for 80% of patients; 52% were 65 years or older. At 1 year, patients starting HD with AVF had improved survival compared to patients who initiated HD through TDC (88% vs. 76%, p<0.001) or through AVG (88% vs. 83%, p<0.001). In patients over 65 who initiate HD with TDC, creation of AVF and AVG are associated with identical survival (p=NS), with both significantly better than continued HD through TDC (p<0.001) (Figure 1).
CONCLUSIONS: Initiation of HD through AVF is associated with improved survival compared to AVG and TDC, but is a small fraction of ESRD patients. In patients over 65 that initiate HD through TDC, creation of AVF is not superior to AVG in terms of survival.
AUTHOR DISCLOSURES: R. Chaer: Nothing to disclose; E. D. Dillavou: Nothing to disclose; M. S. Makaroun: Nothing to disclose; L. K. Marone: Nothing to disclose; T. H. Yuo: Nothing to disclose.
Posted April 2013