Autogenous versus prosthetic vascular access for hemodialysis: A systematic review and meta-analysis
Received 7 August 2008; accepted 9 August 2008.
Objectives
The autogenous arteriovenous access for chronic hemodialysis is recommended over the prosthetic access because of its longer lifespan. However, more than half of the United States dialysis patients receive a prosthetic access. We conducted a systematic review to summarize the best available evidence comparing the two accesses types in terms of patient-important outcomes.
Methods
We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and SCOPUS) and included randomized controlled trials and controlled cohort studies. We pooled data for each outcome using a random effects model to estimate the relative risk (RR) and its associated 95% confidence interval (CI). We estimated inconsistency caused by true differences between studies using the I2 statistic.
Results
Eighty-three studies, of which 80 were nonrandomized, met eligibility criteria. Compared with the prosthetic access, the autogenous access was associated with a significant reduction in the risk of death (RR, 0.76; 95% CI, 0.67-0.86; I2 = 48%, 27 studies) and access infection (RR, 0.18; 95% CI, 0.11-0.31; I2 = 93%, 43 studies), and a nonsignificant reduction in the risk of postoperative complications (hematoma, bleeding, pseudoaneurysm and steal syndrome, RR 0.73; 95% CI, 0.48-1.16; I2 = 65%, 31 studies) and length of hospitalization (pooled weighted mean difference –3.8 days; 95% CI, –7.8 to 0.2; P = .06). The autogenous access also had better primary and secondary patency at 12 and 36 months.
Conclusion
Low-quality evidence from inconsistent studies with limited protection against bias shows that autogenous access for chronic hemodialysis is superior to prosthetic access.
aKnowledge and Encounter Research Unit, Mayo Clinic, Rochester, Minn
bDivision of Preventive Medicine, Mayo Clinic, Rochester, Minn
cDivision of Nephrology, Mayo Clinic, Rochester, Minn
dDivision of Vascular Surgery, Mayo Clinic, Rochester, Minn
eDivision of Endocrinology, Mayo Clinic, Rochester, Minn
fDepartment of Surgery, VA Medical Center, Georgetown and George Washington Universities, Washington, DC
Correspondence: M. Hassan Murad, MD, MPH, Mayo Clinic, Division of Preventive, Occupational and Aerospace Medicine, 200 1st St SW, Rochester, MN 55905
This review was funded by a contract from the Society for Vascular Surgery.
STATEMENT OF CONFLICT OF INTEREST: These authors report that they have no conflicts of interest with the sponsor of this supplement article or products discussed in this article.
ABSTRACT