May 1, 2017

The Effect of Predialysis Fistula Attempt on Risk of All-Cause and Access-Related Death

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This study was designed to determine the proportion of access-related deaths in a retrospective cohort study of 2300 patients aged ≥18 years who initiated hemodialysis between 2004 and 2012 at five Canadian dialysis programs. There was significantly lower mortality in individuals who underwent a predialysis fistula attempt than in those without a predialysis fistula attempt in patients aged <65 years (hazard ratio [HR], 0.49; 95% confidence interval [95% CI], 0.29 to 0.82) and in the first 2 years of follow-up in those aged ≥65 years (HR0–24 months, 0.60; 95% CI, 0.43 to 0.84; HR24+ months, 1.83; 95% CI, 1.25 to 2.67) with only 2.3% of deaths attributable to access.  The authors convincingly suggest that the excess mortality observed in patients treated with catheters does not appear to be due to direct, access-related complications but is likely the result of residual confounding, unmeasured comorbidity, or treatment selection bias.







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Chronic Kidney Disease, Hemodialysis, Vascular Access