Relation between gender and vascular access complications in hemodialysis patients

Native arteriovenous (AV) fistulae for hemodialysis vascular access are bel ieved to be associated with fewer complications than synthetic polytetraflu oroethylene (PTFE) grafts. We conducted a study among patients in the Dialy sis Morbidity and Mortality Study to compare risk factors for complications of AV fistulae and PTFE grafts in men and women and to examine the effect of age on vascular access complications. We analyzed data from 833 incident patients with end-stage renal disease who had a PTFE graft (n = 621) or AV fistula (n = 212) in use 1 month after starting hemodialysis therapy. Foll ow-up using inpatient and outpatient Medicare administrative data identifie d a 1.8-times greater risk for a subsequent vascular access procedure for P TFE grafts (0.71 procedures/access-year) than for AV fistulae (0.39 procedu res/access-year). Men with grafts and women with grafts or fistulae had a g reater risk for a first subsequent access procedure than did men with fistu lae (0.79, 0.65, and 0.59 versus 0.33 procedures/access-year, respectively) . After adjustment for age, race, presence of diabetes mellitus, and histor y of smoking, peripheral vascular disease, and cardiovascular disease, use of a PTFE graft compared with an AV fistula was associated with a greater r isk for a first subsequent procedure in men (relative hazard, 2.2; 95% conf idence interval [CI], 1.6 to 2.9), but not in women (relative hazard, 1.0; 95% CI, 0.7 to 1.4). The excess risk associated with a PTFE graft compared with an AV fistula was limited to men in the lower three quartiles of age ( ie, less than or equal to 72 years). These data raise concern that the pote ntial benefits of AV fistulae over PTFE grafts are not realized in women an d older men. A better understanding of the determinants of successful acces s maturation and maintenance in these groups is needed. (C) 2000 by the Nat ional Kidney Foundation, Inc.