Autogenous versus prosthetic vascular access for hemodialysis: A systematic review and meta-analysis
Journal of Vascular Surgery
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. © 2008 The Society for Vascular Surgery.
Murad, M., Elamin, M., Sidawy, A., Malaga, G., Rizvi, A., Flynn, D., Casey, E., McCausland, F., McGrath, M., Vo, D., El-Zoghby, Z., Duncan, A., Tracz, M., Erwin, P., & Montori, V. (2008). Autogenous versus prosthetic vascular access for hemodialysis: A systematic review and meta-analysis. Journal of Vascular Surgery, 48 (5 SUPPL.). http://dx.doi.org/10.1016/j.jvs.2008.08.044