DETERMINANTS OF TYPE OF INITIAL HEMODIALYSIS VASCULAR ACCESS

Vascular access thrombosis is more common with polytetrafluoroethylene (PTFE) grafts than with native arteriovenous fistulae (AVF). Recent s tudies report an unexplained excess vascular access morbidity in women on hemodialysis. We studied 92 consecutive end-stage renal disease (E SRD) patients receiving their first permanent hemodialysis vascular ac cess at initiation of hemodialysis to identify variables that determin e assignment of either a PTFE graft or a native AVF. Independent varia bles included: age, gender, race, etiology of ESRD, and whether or not access surgery was electively planned before need for dialytic therap y. The 51 women and 41 men included 65 blacks, 13 Hispanics, 11 whites , and 3 Orientals aged 50 +/- (SD) 16 years. Of the 92 subjects, 54 (5 9%) received an AVF, while 38 (41%) received a PTFE graft. 36 (94%) of 38 PTFE grafts were placed in the upper arm as compared with 9 (17%) of 54 AVF (p = 0.0001). Also, 45 (83%) of 54 AVF were placed in the fo rearm as compared with only 2 (6%) of 38 PTFE grafts (p = 0.0001). Wom en were more likely to receive a PTFE graft -28 (55%) of 51 -than men -10 (24%) of 41 (p = 0.003). By contrast, men were more likely to get an AVF -31 (76%) of 41 -than women -23 (45 %) of 51 (p = 0.003). The l og linear analysis confirmed that this finding was significant (p = 0. 0018) for the coefficient of interaction between gender and type of va scular access. No other independent variable had a significant relatio nship with type of vascular access. We conclude that women with ESRD a re more likely to receive a PTFE graft for hemodialysis, while men are more likely to get an AVF. These findings may explain, in part, the r eported excess vascular access morbidity in women on hemodialysis.