Rationale for Guideline for "Preferred Vascular Access"
Preferred vascular access for hemodialysis
Contribution from the Canadian Society of Nephrology Clinical Practice Guidelines Committee
Source: CSN Position Statements extracted from HD CPGs 2006 edition (J Am Soc Nephrol 17: S1-27, 2006):
The preferred type of vascular access is a radio-cephalic native vessel arteriovenous fistula. (Grade C evidence)
Rationale: In observational studies the relative risk of bacteremia is greater with central venous catheters than with AV fistulae1. Compared with AV grafts, AV fistulae have been shown to be associated with better long-term survival, require less intervention to maintain patency, have lower infection rates, and lead to less health care expenditure2-7.
Given the observational nature of the data, and the outcomes (including survival), the evidence is Grade C in quality.
References
- Hoen B, Paul-Dauphin A, Hestin D, Kessler M: EPIBACDIAL: A multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol 9: 869–876, 1998.
- Churchill DN, Taylor DW, Cook RJ, LaPlante P, Barre P, Cartier P, Fay WP, Goldstein MB, Jindal K, Mandin H, et al.: Canadian Hemodialysis Morbidity Study. Am J Kidney Dis 19: 214–234, 1992.
- Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG: Vascular access and all-cause mortality: A propensity score analysis. J Am Soc Nephrol 15: 477–486, 2004.
- Oliver MJ, McCann RL, Indridason OS, Butterly DW, Schwab SJ: Comparison of transposed brachiobasilic fistulas to upper arm grafts and brachiocephalic fistulas. Kidney Int 60: 1532–1539, 2001.
- Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, Coresh J: Type of vascular access and survival among incident hemodialysis patients: The Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol 16: 1449–1455, 2005.
- Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK: Type of vascular access and mortality in US hemodialysis patients. Kidney Int 60: 1443–1451, 2001.
- Manns B, Tonelli M, Yilmaz S, Lee H, Laupland K, Klarenbach S, Radkevich V, Murphy B: Establishment and maintenance of vascular access in incident hemodialysis patients: a prospective cost analysis. J Am Soc Nephrol 16: 201–209, 2005.
