Document Detail

Arteriovenous fistula use and heart disease in long-term elderly hemodialysis patients: analysis of United States Renal Data System Dialysis Morbidity and Mortality Wave II.
MedLine Citation:
PMID:  14736009     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There are some concerns that arteriovenous fistula (AVF) use or other dialysis specific factors may exacerbate cardiovascular disease in long-term hemodialysis (HD) patients. METHODS: We performed a historical cohort study of the United States Renal Data System Dialysis Morbidity and Mortality Wave II study, limited to 993 patients who started HD in 1996 with valid information on vascular access and who were primarily eligible for Medicare at the start of the study. We assessed the association between hemodialysis vascular access and heart disease, defined as Medicare Claims for heart failure (HF, International Classification of Diseases (ICD9) code 428.x) and acute coronary syndromes (ACS, ICD9 code 410.x and 411.x). Cox proportional hazards regression (using propensity analysis) was used to model adjusted hazard ratios (AHR) for the association between patients factors and heart disease after dialysis. RESULTS: The rate of HF per 100 person years at risk (PYAR) was 19.6 among AVF users, 25.7 among patients using polytetrafluoroethylene grafts (grafts), and 31.1 among patients using temporary catheters. Corresponding rates of ACS were 8.2 among AVF users, 11.0 among users of grafts, and 12.4 among users of temporary catheters. In Cox Regression analysis, there was no significant association between AVF use and either HF or ACS. This lack of association was consistent across gender, diabetes, race, and age. CONCLUSIONS: We found that AVF use had no significant association with the incidence of HF or ACS. We conclude that use of AVF by 60 days after the start of dialysis is not associated with an increased risk of later non-fatal cardiovascular outcomes in long-term hemodialysis patients.
Kevin C Abbott; Fernando C Trespalacios; Lawrence Y Agodoa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of nephrology     Volume:  16     ISSN:  1121-8428     ISO Abbreviation:  J. Nephrol.     Publication Date:    2003 Nov-Dec
Date Detail:
Created Date:  2004-01-22     Completed Date:  2004-04-01     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9012268     Medline TA:  J Nephrol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  822-30     Citation Subset:  IM    
Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
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MeSH Terms
Arteriovenous Shunt, Surgical / adverse effects*,  utilization
Catheters, Indwelling
Heart Failure / etiology*
Kidney Failure, Chronic / complications,  therapy
Myocardial Infarction / etiology*
Proportional Hazards Models
Renal Dialysis / adverse effects*
Risk Factors
United States

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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