Are continued policies of prioritizing native vascular access in patients on hemodialysis programs useful?

Ther Apher Dial . 2021 Jul 22. doi: 10.1111/1744-9987.13711. Online ahead of print.

Fecha de la publicación: 22/07/2021

Autor: Sara Ibáñez Pallarès (1, 2), Vicent Esteve Simó (3), Alina Velescu (4), Irati Tapia González (3, 5), Silvia Collado Nieto (6), Albert Clara Velasco (4)

Palabras clave: AV access, dialysis, follow-up, native vascular access, patient-orientated, survival



1Vascular Surgery Department, Hospital de Terrassa, Barcelona, Spain.

2Surgery and Morphologic Sciences Department, Autonomous University of Barcelona (UAB), Barcelona, Spain.

3Nephrology Department, Hospital de Terrassa, Barcelona, Spain.

4Vascular Surgery Department, Hospital del Mar, Barcelona, Spain.

5Medicine Department, Autonomous University of Barcelona, Barcelona, Spain.

6Nephrology Department, Hospital del Mar, Barcelona, Spain.


The guidelines recommend establishing native vascular access as opposed to prosthetic or catheter-based access despite information relating to its effectiveness being scarce from a patient-orientated perspective. We analyzed the effectiveness of a continued policy of native vascular access (CPNVA) in patients undergoing hemodialysis. A retrospective, observational study, including 150 patients undergoing hemodialysis between 2006 and 2012 at our center, and who underwent a CPNVA. Statistical analysis was based on treatment intention. In 138 patients (92%), the first useful access (FUA) was native, and in 12 patients (8%), it was prosthetic. In 50 patients (33.3%), more than one procedure had to be carried out in to order to achieve FUA. The probability of dialysis occurring via a FUA was 67.1% and 45.3% at 1 and 5 years respectively. Over the follow-up period (mean time = 30 months), 84 patients (56%) required repairs or new access, extending the effectiveness of the CPNVA to 88.3% and 73.2% at 1 and 5 years respectively. The effectiveness of the CPNVA was reduced if the patient: required a catheter initially (HR: 3.6, p = 0.007); in cases of initially elevated glomerular filtration rate (HR: 1.1, p = 0.040); in cases of history of previous access failure before FUA (HR: 3.9, p = 0.001); and in female patients (HR: 2.4, p = 0.031). The long-term effectiveness of a CPNVA is high. However, the percentage of patients requiring diverse procedures in order to achieve FUA and the need for re-interventions yield the necessity to optimize preoperative evaluation and postoperative follow-up.