Comparing Long Term Hemodialysis Access Survival between two Non-Autogenous Conduits

Objectives: In end stage renal disease population, there has been an increase in the utilization of non-autogenous conduits for hemodialysis access over the past decade. In this study, we compare long term functional patency between two non-autogenous conduits: bovine biograft and polytetrafluoroethylene (PTFE). Methods: Study include 120 grafts placed in 98 patients between January 2011 and June 2014 in our institution. Various statistical analyses were run via Univariate methods and Kaplan-Meier and Cox regression to evaluate time to loss of patency and identify its predictors. Log rank tests were used to compute differences in survival functions between both groups. Follow-up began at the first time the graft was used for dialysis and ended with an event such as death or study closure. Results: There was no difference in the survival for functionality between PTFE and biograft (Table 1). There was a six fold increase in the loss of functional secondary patency in PTFE compared to biograft (HR: 6.8 95%CI: 1.7-26.3, P=0.006). The survival function for secondary patency was higher for biografts compared to PTFE (x2=7.69, p=0.02). Functional secondary patency at 6months, 1 year and 18 months for biograft and PTFE are 76%, 72%, 72% and 52%, 46%, 46% respectively. Graft infection rates were higher for PTFE compared to biografts (21% Vs 15%). The predictors of patency loss were high-BMI and hyperlipidemia. Conclusions: In our cohort, intervention-free access survival and thrombosis-free access survival are similar between biografts and prosthetic conduits. But, bovine biografts have a significant advantage over PTFE with regards to access survival until abandoned. Patients with high BMI and hyperlipidemia attracted close graft monitoring to improve access survival.