Natural history of arteriovenous grafts in hemodialysis patients

Most hemodialysis patients in the United States have an arteriovenous graft as their vascular access. Grafts have a relatively short life span and are prone to recurrent stenosis and thrombosis, requiring multiple salvage pro cedures to maintain their patency. There is little information in the liter ature regarding the clinical factors that determine graft survival and comp lications. We evaluated prospectively the outcomes of 256 grafts placed at a single institution during a 2-year period. A salvage procedure to maintai n graft patency (thrombectomy, angioplasty, or surgical revision) was requi red in 29% of the grafts at 3 months, 52% at 6 months, 77% at 12 months, an d 96% at 24 months. Thus, primary graft survival (time from graft placement to the first intervention) was only 23% at 1 year and 4% at 2 years. Prima ry graft survival was significantly less among patients with hypoalbuminemi a compared with patients with a normal serum albumin level (P = 0.003). Sec ondary graft survival (time from graft placement to permanent graft failure ) was 65% at 1 year and 51% at 2 years. Neither primary nor secondary graft survival was significantly correlated with patient age, sex, diabetic stat us, body mass index, or graft site. A mean of 1.22 interventions per graft- year were required to maintain access patency, including 0.51 thrombectomie s, 0.54 angioplasties, and 0.17 surgical revisions. In conclusion, hypoalbu minemia is a strong predictor of the requirement for an early graft interve ntion. Patients with hypoalbuminemia may require a heightened index of susp icion in monitoring their grafts for evidence of stenosis. (C) 2000 by the National Kidney Foundation, Inc.