Use of an arteriovenous graft in dialysis increases risk of venous thromboembolism
Compared with the use of an arteriovenous fistula, the use of an arteriovenous graft in dialysis is associated with an increased risk of venous thromboembolism, according to data published in Kidney Medicine.
“Compared with the general population, patients with kidney failure receiving maintenance hemodialysis face higher risks of both bleeding and thrombosis,” Nicholas S. Roetker, PhD, MS, from the Chronic Kidney Disease Research Group at Hennepin Healthcare Research Institute in Minnesota, and colleagues wrote. They added, “Although an arteriovenous (AV) fistula is generally preferred to an AV graft to minimize vascular access complications, given recent guidelines suggesting tailoring the access type to the clinical circumstances of each patient, a better understanding of the risks of bleeding, thrombosis, and other cardiovascular endpoints could help guide the choice of the type of permanent AV access.”
In an observational cohort study, researchers examined Medicare beneficiaries who recently started using an AV access for hemodialysis. A total of 17,763 patients used an AV graft, and 60,329 patients used an AV fistula. Data were derived from the 2010 to 2015 U.S. Renal Data System End-Stage Renal Disease registry database.
Primary outcomes of the study included major bleeding, venous thromboembolism, ischemic stroke, myocardial infection, cardiovascular death and critical limb ischemia.
Researchers used Poisson regression to predict the 3-year incidence rates and incidence rate ratios of each outcome.
Researchers identified 10.8 venous thromboembolism events per 100 person-years among patients using AV grafts, whereas 5.3 venous thromboembolism events per 100 person-years occurred among patients using AV fistulas. Therefore, the use of AV grafts in hemodialysis correlated with an increased risk of venous thromboembolism compared with AV fistulas. Additionally, analyses revealed AV graft use potentially correlated with an increased risk of cardiovascular death.
“Our findings are potentially important when physicians and other providers work with patients to select the optimal access for HD. Current guidelines are based on the principle of obtaining ‘the right access, in the right patient, at the right time, for the right reasons.’ It appears, at least in the case of older patients, that neither the risk of major bleeding nor major cardiovascular events are important factors in this calculus,” Roetker and colleagues wrote. “However, a nearly twofold increase in the risk of venous thromboembolism associated with the use of AVGs provides a basis for discussion about the risks incurred by AVG users compared with AVF users when attempting to select an optimal access for a given patient.”
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