Open Access

Outcomes of arteriovenous graft vs. fistula for haemodialysis access in the elderly: A systematic review and meta‑analysis

  • Authors:
    • Jia Li
    • Hua Lu
    • Zhen Xie
    • Qingchao Li
    • Hongguang Shi
  • View Affiliations

  • Published online on: July 6, 2023     https://doi.org/10.3892/etm.2023.12098
  • Article Number: 399
  • Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

The impact of the type of vascular access on the outcomes in the elderly haemodialysis patients is still unclear. The goal of the present study was to compare survival outcomes in elderly haemodialysis patients who received either arteriovenous graft (AVG) or arteriovenous fistula (AVF). A systematic literature search was performed in EMBASE, Cochrane, MEDLINE, ScienceDirect and Google Scholar databases for papers published from January 1954 until January 2022. Risk of bias in the selected publications was assessed by Newcastle Ottawa scale or Cochrane risk of bias tool depending on the study design. Meta‑analysis was carried out using the random‑effects model. Data were reported as pooled odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI). A total of 12 studies were included in the analysis. The majority of the studies had poor quality. Elderly patients receiving AVG had significantly worse survival rate compared with patients that received AVF for the haemodialysis access, with a pooled HR of 1.38 (95% CI, 1.24‑1.53; I2=79.9%). Pooled HR for access survival was 1.60 (95% CI, 1.54‑1.66; I2=0%). Pooled OR for primary patency rate, maturation failure and infections were 1.81 (95% CI, 0.73‑4.49; I2=79.2%), 0.33 (95% CI, 0.12‑0.91; I2=70.4%) and 9.74 (95% CI, 2.60‑36.49; I2=52.4%), respectively. These results suggested that in elderly patients undergoing haemodialysis, AVG was associated with reduced overall survival and access survival, and higher infection rate, compared with AVF. Notably, AVG was also associated with a lower risk of maturation failure, presenting a potential advantage in specific patient populations (study registration: PROSPERO, no. CRD42022313199).

Introduction

Almost 3 million people worldwide receive haemodialysis treatment every year, and this number is expected to double by the year 2030(1). More than half of all haemodialysis patients are elderly (aged ≥65 years) (1). For this population, well-timed placement of an arteriovenous (AV) vascular access by AV graft (AVG) or AV fistula (AVF) may limit the usage of a tunnelled central venous catheter (CVC) (2). This is important as a well-timed placement of AV access in elderly haemodialysis patients may reduce the risk of complications, such as infection and thrombosis, that are associated with prolonged use of tunnelled CVCs, thereby improving the quality of care and overall prognosis of the patient (2). Currently, the general guidelines for selecting a dialysis vascular access include a categorized preference order, where AVF, AVG and CVC are the first, second and last choice, respectively (3). AVFs are often selected as the first choice due to their longer patency and lower infection rates. However, AVF maturation process can be slow and unpredictable, posing unique challenges for elderly patients. On the other hand, AVGs, while quicker to mature, are traditionally associated with a higher rate of complications, which often makes them a less preferred method of dialysis vascular access (3).

This categorized preference order for the placement of vascular access has become a major point of debate worldwide (4,5). For decades, AVF placement was considered a preferred method of choice for the majority of patients that required haemodialysis for treating end-stage kidney disease (ESKD). However, recent advances in the treatment of ESKD led to the changes in the incidence and prevalence of patients with advanced renal conditions (6). Changes in the treatment of ESKD have also changed our understanding of the pros and cons associated with different vascular access options. With increasing complexity of the health profiles of patients, particularly among elderly populations, it is necessary to reassess the efficacy and safety of AVGs and AVFs.

Haemodialysis is now offered to elderly ESKD patients with various comorbidities, such as diabetes mellitus, hypertension, cardiovascular disease, chronic respiratory conditions, osteoporosis, and autoimmune disorders such as lupus. Age is a major biological variable that can affect the outcomes of vascular access (7). The optimal vascular access (VA) strategy in elderly dialysis patients is still unclear due to their shorter life expectancy, difficulties in VA maturation and significantly higher risk of primary AVF failure compared to younger adults (8). Recent studies in elderly patients suggest that AVF may not demonstrate clear advantage over AVG in terms of patency. Therefore, patients can still benefit from AVG, as it is associated with a shorter time to maturation (9-11). To the best of our knowledge, there are no reviews that pool data on the difference in outcomes, such as overall survival, mortality rates, access survival, primary patency, maturation failure and risk of infection in elderly patients. The goal of the present study is to summarize data from individual studies to compare the outcomes of AVG versus AVF for haemodialysis access in elderly patients.

Materials and methods

Eligibility criteria

Study design. Randomized controlled trials/non-randomized trials/cross-sectional/cohort/case-control studies were included if they satisfied the inclusion criteria listed below.

Study participants. Studies containing data of elderly patients (≥60 years) requiring haemodialysis access were incorporated.

Exposure. Studies evaluating the difference in outcomes between AVF and AVG access for elderly patients were included.

Outcomes. Studies reporting any of the following outcomes: Overall survival/mortality rates, access survival, primary patency, maturation failure and infection, were eligible for inclusion.

Exclusion criteria. Case reports, case series, conference abstracts, letters to editors, commentaries and studies not reporting any of the aforementioned outcomes were excluded from the analysis.

Search strategy

Systematic literature search was conducted in EMBASE (https://www.embase.com/), Cochrane library (https://www.cochranelibrary.com/search), MEDLINE (https://pubmed.ncbi.nlm.nih.gov/), Google Scholar (https://scholar.google.com/) and ScienceDirect (https://www.sciencedirect.com/) databases and search engines (Appendix S1). The search strategy used a combination of medical subject headings (MeSH) and free-text terms using the suitable Boolean operators (‘AND’ and ‘OR’). The following filters were applied during the search: Time point (January 1954 to January 2022), language (English only). Bibliography of the retrieved articles was also searched to find additional relevant studies (Data S1).

Study selection process

The title and abstract were screened by two independent investigators (JL and HL). Full text of the studies that met the inclusion criteria were retrieved and further screened by the same investigators (JL and HL) for studies that satisfied the inclusion criteria. Disagreements were solved by discussion with the third investigator (ZX). The review was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement 2020(12).

Data extraction process

Data was manually extracted using a pre-defined structured data extraction form and included authors, title of study, year of publication, study period, study design, setting, country/region, total sample size, outcome assessment details, average age, primary and secondary outcomes in each group. Data entry was done by the first author (JL) and checked for any potential errors by the second author (HL).

Risk of bias assessment

Two independent authors (ZX and QL) carried out assessment of the risk of bias using Newcastle Ottawa (NO) scale for observational studies and Cochrane Risk of bias 2 (RoB 2 tool) for randomized controlled trials. NO scale included the following domains: Selection (four stars), comparability (two stars) and outcome (three stars). The final score ranged from zero to eight stars. Studies ranging from 7-9 stars indicated ‘good quality’. Quality of the studies with 5-6 stars were considered ‘satisfactory’, and studies with 0-4 stars were considered ‘unsatisfactory’ (13).

The RoB-2 tool was structured into a following domains of bias: Process of randomization, variation from the intended intervention, missing data on outcomes, outcome measurements and selection of the reported results.

Based on results of the NO scale and RoB2 tool assessment, quality of evidence of each study was then categorised as having ‘low bias risk’, ‘high bias risk’, and ‘some concerns’ (14).

Statistical analysis

Meta-analysis was performed using STATA version 14.2 (StataCorp LLC). For the binary outcomes, the data were reported as pooled odds ratio (OR) with 95% confidence interval (CI). For time to event data (mortality and access free survival), pooled estimate were calculated using natural logarithm of hazard ratio (ln{HR}) and standard error of ln(HR). First, HR with 95% Confidence interval (CI) was retrieved from the included studies. Natural logarithm of HR was calculated for each of the HR estimate. Standard error of ln(HR) was calculated using the following equations (15):

Variance of logarithmic HR was calculated as follows: Variance (ln{HR})=[ln(upper CI of HR)-ln(lower CI of HR)/2x1.96]

Standard error (SE) of logarithmic HR was calculated as follows: SE (ln{HR})=√Variance (ln{HR})

Values of ln(HR)and SE were then entered into the STATA software to estimate the pooled effect. Random effects model was applied, and the data were reported as pooled HR with 95% CI for both outcomes. Visual representation of the pooled estimates were performed using Forest plots.

Heterogeneity was evaluated using χ2 test and I2 statistic. I2<25% indicated mild heterogeneity; 25-75% indicated moderate heterogeneity; and >75% indicated substantial heterogeneity (16). Sensitivity analysis was performed to evaluate the robustness of pooled estimate. Assessment of publication bias through funnel plot and Egger's test could not be performed for any of outcomes due to an insufficient (<10) number of studies reporting each outcome.

Results

Study selection

Literature search identified 3,489 papers. Of them, 145 studies were eligible for full text evaluation. In addition, six more articles were retrieved by screening the references of the full texts during primary screening. After the final screening, 12 studies containing 95,449 participants met the eligibility criteria and were included in the analysis (Fig. 1) (9-11,17-25).

Characteristics of the included studies

All studies, except Murea et al (17) and Robinson et al (18), were retrospective. Most (eight out of 12) were conducted in the USA followed by South Korea (3 studies). The range of sample sizes was 29 to 25,226. The majority of the studies were conducted in patient cohorts with >65 years cut-off followed by >75 years cut-off. The follow-up duration ranged from 215 days to 5 years (Table I). Overall, nine out of 12 studies had higher risk of bias (Table II and III).

Table I

Characteristics of the included studies (n=12).

Table I

Characteristics of the included studies (n=12).

First author, yearCountryStudy designSample sizeAge cut-off, yearsMean age, yearsMales, %Mean BMI, kg/m2DM, %HTN, %CAD, %Cancer, %Follow-up durationOutcomes measured(Refs.)
Arhuidese et al, 2019USARetrospective23,653>75AVG=82.2AVG=45.4AVG=26.9AVG=48AVG=87.3AVG=28AVG=10.75-yearOverall survival, infection, primary patency(9)
     AVF=82.0AVF=65.8AVF=26.8AVF=43AVF=88.9AVF=29.5AVF=11.7   
Bae et al, 2018South KoreaRetrospective361>65AVG=74.9AVG=57.7AVG=22.7AVG=55.7AVG=72.2AVG=28.9AVG=18.35-yearOverall survival, Maturation failure(10)
     AVF=74.2AVF=54.8AVF=22.8AVF=55.4AVF=78AVF=19AVF=23.2   
Choi et al, 2020South KoreaRetrospective878>65AVG=61AVG=52.9NRAVG=71.2NRAVG=20.4NRNRAccess free survival(11)
     AVF=59AVF=60.9 AVF=62.7 AVF=16    
Cui et al, 2016ChinaRetrospective182>75NRAVG=56.8NRAVG=56.8AVG=93.2AVG=52.3NR2-yearMaturation failure(22)
      AVF=65.2 AVF=47.1AVF=93.5AVF=55.8    
Jadlowiec et al, 2016USARetrospective186>70AVG=78AVG=42.9NRAVG=59.5AVG=89.2AVG=75.7NRNRMortality, Infection, patency, maturation failure(21)
     AVF=78.8AVF=59.7 AVF=57AVF=94AVF=73.2    
Jhee et al, 2019SouthRetrospective4,026>65AVG=74.3AVG=52.2AVG=21.9AVG=41.1AVG=52.4AVG=13.8AVG=2.5NROverall survival(25)
 Korea   AVF=73AVF=58.4AVF=22.3AVF=40.3 AVF=14AVF=2.8   
Lee et al, 2019USARetrospective14,37065-74AVG=65AVG=87.5NRNRNRNRNRNROverall survival, access free survival(23)
     AVF=60AVF=54.4        
Murea et al, 2020USARCT44>65AVG=72.8AVG=52.2AVG=30.9AVG=65.2AVG=87AVG=13AVG=26.1215 daysMortality(17)
     AVF=78.9AVF=71.4AVF=25.5AVF=76.2AVF=90.5AVF=9.5AVF=23.8   
Robinson et al, 2021USARCT29>65AVG=77.5AVG=56AVG=30.3AVG=56AVG=82AVG=11AVG=22321 daysMortality, infection, maturation failure(18)
     AVF=75.4AVF=78AVF=27.6AVF=67AVF=89AVF=22AVF=22   
Saleh et al, 2017USARetrospective10,03070-80AVG=70.7AVG=91NRAVG=67NRAVG=26AVG=26NROverall survival(20)
     AVF=70.2AVF=96 AVF=66 AVF=24AVF=25   
Woo et al, 2015USARetrospective16,464>66AVG=78AVG=55.6NRAVG=77.5AVG=99.1AVG=82.9AVG=15.81 yearMortality(19)
     AVF=77.1AVF=40.6 AVF=73.2AVF=99AVF=79.8AVF=15   
Xue et al, 2003USARetrospective25,226>67AVG=74.9AVG=57NRAVG=39.2NRNRNR1 yearMortality(24)
     AVF=74.6AVF=62.2 AVF=37.8      

[i] BMI, body mass index; DM, diabetes Mellitus; HTN, hypertension; CAD, coronary artery disease; NR, not reported; RCT, randomized controlled trial; USA, United States of America.

Table II

Quality assessment for observational studies amongst the included studies (n=10).

Table II

Quality assessment for observational studies amongst the included studies (n=10).

Study no.First author, year RepresentativenessSample size justificationNon-responseAscertainment of exposureControl for confoundingAssessment of outcomeStatistical testsOverall Quality(Refs.)
1Arhuidese et al, 20190 star0 star0 star1 star1 star1 star1 starPoor(9)
2Bae et al, 20180 star1 star1 star1 star1 star1 star1 starPoor(10)
3Choi et al, 20200 star0 star1 star0 star0 star1 star1 starPoor(11)
4Cui et al, 20160 star1 star0 star0 star0 star1 star0 starPoor(22)
5Jadlowiec et al, 20160 star0 star0 star1 star1 star1 star1 starSatisfactory(21)
6Jhee et al, 20190 star0 star0 star1 star2 stars1 star1 starSatisfactory(25)
7Lee et al, 20190 star1 star1 star1 star0 star1 star0 starPoor(23)
8Saleh et al, 20170 star0 star1 star1 star0 star1 star1 starPoor(20)
9Woo et al, 20150 star0 star0 star0 star0 star1 star1 starPoor(19)
10Xue et al, 20030 star0 star0 star0 star0 star1 star0 starPoor(24)

Table III

Quality assessment for RCTs amongst the included studies (n=2).

Table III

Quality assessment for RCTs amongst the included studies (n=2).

Study no.First author, yearRandomization processDeviation from intended interventionMissing outcome dataMeasurement of outcomeSelection of reported resultOverall risk of bias(Refs.)
1Murea et al, 2020Low riskLow riskSome concernsHigh riskHigh riskHigh risk(17)
2Robinson et al, 2021Low riskLow riskLow riskSome concernsLow riskSome concerns(18)
Overall survival

Firstly, five studies (9,10,20,23,25) reported the difference in overall survival between elderly patients that received AVG and AVF for haemodialysis access. The pooled HR was 1.38 (95% CI, 1.24-1.53; I2=79.9%), which suggested that AVG was associated with significantly decreased survival compared with AVF in elderly patients (Fig. 2).

Then, seven studies (9,10,17-19,21,24) compared the mortalities in elderly patients that received AVG and AVF for haemodialysis access. The pooled OR was 1.23 (95% CI, 1.09-1.40; I2=75.1%), further confirming that elderly patients receiving AVG access for haemodialysis had significantly higher rate of mortality when compared with patients with AVF (Fig. 3).

Access survival

Next, two studies (11,23) compared the access survival in AVG and AVF groups of elderly patients. The pooled HR of 1.60 (95% CI, 1.54-1.66; I2=0%) indicated that AVG was associated with significantly worse access survival compared with AVF in elderly haemodialysis patients (Fig. 4).

Two additional studies (9,21) have reported the difference in primary patency rate (intervention-free access survival) in terms of count outcomes between the two groups of patients. The pooled OR was 1.81 (95% CI, 0.73-4.49; I2=79.2%), not indicating any significant difference in terms of primary patency rate between AVG and AVF groups (Fig. 5).

Maturation failure

There were four studies (10,11,18,21) that reported the difference in maturation failure between AVG and AVF groups of elderly haemodialysis patients. The pooled OR was 0.33 (95% CI, 0.12-0.91; I2=70.4%) indicating that patients undergoing AVG had significantly lower risk of maturation failure when compared with patients undergoing AVF (Fig. 6).

Infection

Finally, three studies (9,18,21) reported the difference in infection rate in terms of count outcomes between AVG and AVF groups of elderly patients. The pooled OR was 9.74 (95% CI, 2.60-36.49; I2=52.4%) indicating that there is 9-fold higher risk of infection in patients who received AVG haemodialysis access compared with patients with AVF (Fig. 7).

Additional analysis

Sensitivity analysis was performed to check the small study effects by removing each of the studies one-by-one for all outcomes. No significant variation in the effect size (magnitude and direction) was detected by the sensitivity analysis. This indicated a lack of single study effect on the overall estimate for any of the outcomes.

Discussion

The current recommended guidelines for vascular access do not provide any specific age-based recommendations for the preferred placement of AVF over the AVG (3). Elderly patients undergoing haemodialysis present unique challenges, such as diminished vein and elasticity, high prevalence of atherosclerosis, increased risk of infection and comorbidities, for the establishment and usage of the vascular access (4). The present systematic review assessed the risk of survival outcomes associated with AVG and AVF access for haemodialysis among elderly patients.

The present study investigated 12 studies that fulfilled the eligibility criteria. The majority of these studies were conducted in the USA followed by South Korea and China. Almost all the studies [except for Murea et al (17) and Robinson et al (18)] were retrospective, and the majority of them were of poorer quality with a high risk of bias. It was revealed that AVG was associated with significantly higher risk of mortality, lower access survival and higher rate of infection. At the same time, AVG access in these patients correlated with significantly lower risk of maturation failure. Though subgroup analysis was not possible due to limited number of studies for each outcome, there was some variation in the individual study estimates based on the age cut-off, with higher magnitude of association in higher-age group of patients. Sensitivity analysis did not reveal significant effect of any single study on the magnitude or direction of association.

These results were further confirmed by using adjusted HR for the pooling of effect size. The crude estimates are prone for confounding as they are not adjusted for any important risk factors. The use of adjusted HR takes into account these relevant confounding factors, and thus provides more reliable estimate of the differences between the two vascular access methods in elderly patients. While there are no existing reviews to compare the observations of the present study in an elderly age group, the current results were in agreement with the reviews that focused on adult patients and compared AVG and AVF for haemodialysis access (26-28). A possible explanation for the observed differences in the outcomes between these two haemodialysis access types may be due to a higher rate of infections as a result of the colonization of the foreign materials within the vascular space by skin microorganisms. This may lead to poor overall survival and access survival in patients undergoing AVG for haemodialysis access (26).

The increased mortality rate associated with AVG when compared with AVF in the elderly population cannot be solely attributed to the choice of vascular access. It is important to consider that the selection between AVG and AVF is typically dictated by patient-specific factors such as vascular health, comorbidities, and the overall clinical profile of the patient (4). This introduces an inherent selection bias that may lead to worse outcomes in patients approved for AVG.

An important finding of the present study is the higher rate of infection in patients with AVG. However, the present analysis did not distinguish between infections at the access site and systemic events, nor was the severity of these infections graded. Future studies should consider investigating these aspects in more detail, as the type and severity of infection could influence the decision-making process regarding the choice of access type.

AVFs have a significantly higher risk of the maturation failure, often requiring various intercurrent guidelines strongly recommend AVF as a first-line and optimal vascular access method for haemodialysis. There is insufficient information available for evaluating the qualities of this methods (29). Since AVF is associated with higher maturation failure and frequently requires repetitive interventions, its indiscriminate use might result in the ineffective usage of the services and resources (29).

The major strength of the present review was the rigorous methodology and comprehensive literature search that adds to the limited evidence available on the comparison these two methods of vascular access. The present study did not detect any significant changes in the effect size, as indicated by the sensitivity analysis. This further enhanced the credibility of these results. However, there are some limitations in the current study. Substantial between-study variability was found for most of the outcomes. The majority of the studies were of poorer quality and limited heterogeneity. This might affect the external validity (generalisability) of the findings. In addition, publication bias was unable to be assessed due to the small number of studies, which further limits the credibility of the evidence. The retrospective nature of the included studies made it challenging to establish the causal association. Hence, longitudinal evidence is required for the identification of reliable effect size. This will allow making evidence-based recommendations for deciding on the appropriate vascular access type for elderly haemodialysis patients at the hospital setting. Finally, the results of the present review may not be credible as nine out of the 12 studies had high-risk of bias. Given these limitations, it is crucial to stress that the present results should not be interpreted as definitive evidence for the decision-making in the clinical setting. The small number and the retrospective design of most of the included studies, and other potential biases restrict us from deriving firm evidence-based recommendations from this meta-analysis.

Nevertheless, the present study had certain important implications for the healthcare professionals treating elderly haemodialysis patients. A stronger association of survival outcomes was revealed with AVG compared with AVF in elderly patients. However, the maturation failure was higher with AVF and limited evidence was available in terms of RCTs. The potential confounding effect of infections on survival analyses was also notable. Although the meta-analysis showed a worse survival rate with AVG, whether this was influenced by the increased rate of infections in this group was not specifically investigated. Thus, the impact of infections on survival outcomes remains unclear. In the future, more rigorous statistical methods may be necessary to control for such confounding factors and accurately determine the individual effects of AVG and AVF on survival rates in the elderly.

While the current analysis revealed a stronger association of survival outcomes with AVG compared with AVF in elderly patients, a higher maturation failure rate was observed with AVF. The limited availability of RCTs evidence restricted the current study from deriving firm evidence-based recommendations from the results. However, importantly, the KDOQI guidelines recommend basing the decision on vascular access not only on the age of the patient or access type but to follow a comprehensive, individualized life plan that takes into consideration the history of the patient, comorbidities, vascular health, life expectancy and future needs. These guidelines should be considered when deciding on the appropriate access type for each elderly haemodialysis patient.

Supplementary Material

Data S1

Acknowledgements

Not applicable.

Funding

Funding: No funding was received.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Authors' contributions

JL conceived and designed the study. HL, ZX, QL and HS collected the data and performed the literature search. JL was involved in the writing of the manuscript. All authors have read and approved the final manuscript. JL,HL, ZX, QL and HS confirm the authenticity of all the raw data.

Ethical approval and consent to participate

Not applicable.

Patient consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

References

1 

Liyanage T, Ninomiya T, Jha V, Neal B, Patrice HM, Okpechi I, Zhao MH, Lv J, Garg AX, Knight J, et al: Worldwide access to treatment for end-stage kidney disease: A systematic review. Lancet. 385:1975–1982. 2015.PubMed/NCBI View Article : Google Scholar

2 

Besarab A: Resolved: Fistulas are preferred to grafts as initial vascular access for dialysis. Pro. J Am Soc Nephrol. 19:1629–1633. 2008.PubMed/NCBI View Article : Google Scholar

3 

Vascular Access 2006 Work Group. Vascular access 2006 work group: Clinical practice guidelines for vascular access. Am J Kidney Dis. 48 (Suppl 1):S176–S247. 2006.PubMed/NCBI View Article : Google Scholar

4 

Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, Canaud BJ and Pisoni RL: Vascular access use and outcomes: An international perspective from the dialysis outcomes and practice patterns study. Nephrol Dial Transplant. 23:3219–3226. 2008.PubMed/NCBI View Article : Google Scholar

5 

Lok CE: Fistula first initiative: Advantages and pitfalls. Clin J Am Soc Nephrol. 2:1043–1053. 2007.PubMed/NCBI View Article : Google Scholar

6 

Bikbov B, Purcell CA and Levey AS: HYPERLINK ‘https://www.researchgate.net/scientific-contributions/Mari-Smith-2131815162’. Smith M and Abdoli A: HYPERLINK ‘https://www.researchgate.net/profile/Molla-Abebe’. Abebe M, Adebayo O, Afarideh M, Agarwal S, Agudelo-Botero M, et al: Global, regional, and national burden of chronic kidney disease, 1990-2017: A systematic analysis for the global burden of disease study 2017. The Lancet. 395:709–733. 2020.PubMed/NCBI View Article : Google Scholar

7 

Cortés MJ, Viedma G, Perales MC, Borrego FJ, Borrego J, del Barrio PP, Cunquero JMG, Liébana A and Bañasco VP: Fistulae or catheter for elderly who start hemodialysis without permanent vascular access? Nefrologia. 25:307–314. 2005.PubMed/NCBI(In Spanish).

8 

Murea M and Satko S: Looking beyond ‘fistula first’ in the elderly on hemodialysis. Semin Dial. 29:396–402. 2016.PubMed/NCBI View Article : Google Scholar

9 

Arhuidese IJ, Cooper MA, Rizwan M, Nejim B and Malas MB: Vascular access for hemodialysis in the elderly. J Vasc Surg. 69:517–525.e1. 2018.PubMed/NCBI View Article : Google Scholar

10 

Bae E, Lee H, Kim DK, Oh KH, Kim YS, Ahn C, Han JS, Min SII, Min SK, Kim HC and Joo KW: Autologous arteriovenous fistula is associated with superior outcomes in elderly hemodialysis patients. BMC Nephrol. 19(306)2018.PubMed/NCBI View Article : Google Scholar

11 

Choi J, Ban TH, Choi BS, Baik JH, Kim BS, Kim YO, Park CW, Yang CW, Jin DC and Park HS: Comparison of vascular access patency and patient survival between native arteriovenous fistula and synthetic arteriovenous graft according to age group. Hemodial Int. 24:309–316. 2020.PubMed/NCBI View Article : Google Scholar

12 

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, et al: The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ. 372(n71)2021.PubMed/NCBI View Article : Google Scholar

13 

Wells G, Shea B, O'Connell D, Peterson J, Welch V, Losos M and Tugwell P: The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta- analysis. The Ottawa Hospital Research Institute. 21:2021.

14 

Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng HY, Corbett MS, Eldridge SM, et al: RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ. 366(l4898)2019.PubMed/NCBI View Article : Google Scholar

15 

Parmar MK, Torri V and Stewart L: Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med. 17:2815–2834. 1998.PubMed/NCBI View Article : Google Scholar

16 

Higgins JPT and Green S: Cochrane Handbook for Systematic Reviews of Interventions, 2022.

17 

Murea M, Geary RL, Houston DK, Edwards MS, Robinson TW, Davis RP, Hurie JB, Williams TK, Velazquez-Ramirez G, Bagwell B, et al: A randomized pilot study to evaluate graft versus fistula vascular access strategy in older patients with advanced kidney disease: Results of a feasibility study. Pilot Feasibility Stud. 6(86)2020.PubMed/NCBI View Article : Google Scholar

18 

Robinson T, Geary RL, Davis RP, Hurie JB, Williams TK, Velazquez-Ramirez G, Moossavi S, Chen H and Murea M: Arteriovenous fistula versus graft access strategy in older adults receiving hemodialysis: A pilot randomized trial. Kidney Med. 3:248–256.e1. 2021.PubMed/NCBI View Article : Google Scholar

19 

Woo K, Goldman DP and Romley JA: Early failure of dialysis access among the elderly in the era of fistula first. Clin J Am Soc Nephrol. 10:1791–1798. 2015.PubMed/NCBI View Article : Google Scholar

20 

Saleh T, Sumida K, Molnar MZ, Potukuchi PK, Thomas F, Lu JL, Gyamlani GG, Streja E, Kalantar-Zadeh K and Kovesdy CP: Effect of age on the association of vascular access type with mortality in a cohort of incident end-stage renal disease patients. Nephron. 137:57–63. 2017.PubMed/NCBI View Article : Google Scholar

21 

Jadlowiec CC, Mannion EM, Lavallee M and Brown MG: Hemodialysis access in the elderly: Outcomes among patients older than seventy. Ann Vasc Surg. 31:77–84. 2016.PubMed/NCBI View Article : Google Scholar

22 

Cui J, Steele D, Wenger J, Kawai T, Liu F, Elias N, Watkins MT and Irani Z: Hemodialysis arteriovenous fistula as first option not necessary in elderly patients. J Vasc Surg. 63:1326–1332. 2016.PubMed/NCBI View Article : Google Scholar

23 

Lee HS, Song YR, Kim JK, Joo N, Kim C, Kim HJ and Kim SG: Outcomes of vascular access in hemodialysis patients: Analysis based on the Korean national health insurance database from 2008 to 2016. Kidney Res Clin Pract. 38:391–398. 2019.PubMed/NCBI View Article : Google Scholar

24 

Xue JL, Dahl D, Ebben JP and Collins AJ: The association of initial hemodialysis access type with mortality outcomes in elderly Medicare ESRD patients. Am J Kidney Dis. 42:1013–1019. 2003.PubMed/NCBI View Article : Google Scholar

25 

Jhee JH, Hwang SD, Song JH and Lee SW: The impact of comorbidity burden on the association between vascular access type and clinical outcomes among elderly patients undergoing hemodialysis. Sci Rep. 9(18156)2019.PubMed/NCBI View Article : Google Scholar

26 

Ravani P, Palmer SC, Oliver MJ, Quinn RR, MacRae JM, Tai DJ, Pannu NI, Thomas C, Hemmelgarn BR, Craig JC, et al: Associations between hemodialysis access type and clinical outcomes: A systematic review. J Am Soc Nephrol. 24:465–473. 2013.PubMed/NCBI View Article : Google Scholar

27 

Bylsma LC, Gage SM, Reichert H, Dahl SLM and Lawson JH: Arteriovenous Fistulae for Haemodialysis: A systematic review and meta-analysis of efficacy and safety outcomes. Eur J Vasc Endovasc Surg. 54:513–522. 2017.PubMed/NCBI View Article : Google Scholar

28 

Almasri J, Alsawas M, Mainou M, Mustafa RA, Wang Z, Woo K, Cull DL and Murad MH: Outcomes of vascular access for hemodialysis: A systematic review and meta-analysis. J Vasc Surg. 64:236–243. 2016.PubMed/NCBI View Article : Google Scholar

29 

Palmer SC, McGregor DO, Macaskill P, Craig JC, Elder GJ and Strippoli GFM: Meta-analysis: Vitamin D compounds in chronic kidney disease. Ann Intern Med. 147:840–853. 2007.PubMed/NCBI View Article : Google Scholar

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August-2023
Volume 26 Issue 2

Print ISSN: 1792-0981
Online ISSN:1792-1015

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Copy and paste a formatted citation
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Spandidos Publications style
Li J, Lu H, Xie Z, Li Q and Shi H: Outcomes of arteriovenous graft vs. fistula for haemodialysis access in the elderly: A systematic review and meta‑analysis. Exp Ther Med 26: 399, 2023.
APA
Li, J., Lu, H., Xie, Z., Li, Q., & Shi, H. (2023). Outcomes of arteriovenous graft vs. fistula for haemodialysis access in the elderly: A systematic review and meta‑analysis. Experimental and Therapeutic Medicine, 26, 399. https://doi.org/10.3892/etm.2023.12098
MLA
Li, J., Lu, H., Xie, Z., Li, Q., Shi, H."Outcomes of arteriovenous graft vs. fistula for haemodialysis access in the elderly: A systematic review and meta‑analysis". Experimental and Therapeutic Medicine 26.2 (2023): 399.
Chicago
Li, J., Lu, H., Xie, Z., Li, Q., Shi, H."Outcomes of arteriovenous graft vs. fistula for haemodialysis access in the elderly: A systematic review and meta‑analysis". Experimental and Therapeutic Medicine 26, no. 2 (2023): 399. https://doi.org/10.3892/etm.2023.12098