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Controversies and Concerns in Hemodialysis
Series Editor: Marcello Tonelli: What’s Next After Fistula First : Is an Arteriovenous Graft or Central Venous Catheter Preferable When an Arteriovenous Fistula Is Not Possible?
Author(s) -
James Matthew T.,
Manns Braden J.,
Hemmelgarn Brenda R.,
Ravani Pietro
Publication year - 2009
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2009.00633.x
Subject(s) - medicine , arteriovenous fistula , hemodialysis , observational study , vascular access , central venous catheter , catheter , fistula , intensive care medicine , hemodialysis access , clinical trial , surgery , randomized controlled trial
Findings from observational studies have established that the arteriovenous fistula (AVF) is the preferred form of vascular access for chronic hemodialysis. Unfortunately, in a subset of patients with end‐stage renal disease, an AVF cannot be placed or fails to mature. In these patients an alternate form of vascular access, either an arteriovenous graft (AVG) or central venous catheter (CVC) must be selected. In this review we discuss the findings and limitations of studies examining the effect of access type (AVG or CVC) on clinical endpoints including mortality, quality of life, occurrence of infections, as well as the impact of the different access types on resource requirements. Specifically, we examine whether findings from previous studies are valid and applicable to patients for whom an AVF is not possible, and outline the need for future randomized clinical trials addressing this question.