Early Cannulation versus Standard Arteriovenous Grafts in Hemodialysis Patients A Randomized Clinical Study.

Abstract

OBJECTIVE\nArteriovenous grafts (AVGs) are frequently needed in hemodialysis (HD) patients with unsuitable superficial veins. First cannulation of standard arteriovenous grafts (sAVGs) still require about two weeks after implantation. Early cannulation arteriovenous grafts (eAVGs) were suggested to overcome this shortcoming. The present randomized study proposed to compare the clinical outcomes of sAVGs and eAVGs in HD patients.\n\n\nMETHODS\nThe present single-center randomized clinical study recruited 477 HD patients indicated for AVG creation. They included 236 in the sAVG group and 241 in the eAVG group. Eligible patients were simply randomized and allocated to the studied groups using 1:1 allocation ratio. Blinding was secured using the sealed envelope technique. Enrolled patients were followed up for 12 months. The primary outcome in the present study was primary, primary assisted and secondary patency rates at 12 months. Other outcome parameters included time to first cannulation, graft complications and mortality.\n\n\nRESULTS\nComparison between the studied groups regarding the primary outcomes revealed no statistically significant differences. Primary patency rate was 70.8 % and 69.7 % (p=0.8) at 6 months and in 59.3 % and 61.0 % (p=0.71) at 12 months in sAVG and eAVG groups respectively. Primary assisted patency rate was 70.8 % and 69.7 % (p=0.8) in patients with sAVG and eAVG while the reported rates at 12 months were 59.3 % and 61.0 % (p=0.71) respectively. Secondary patency rate was 78.4 % and 73.9 % (p=0.25) at 6 months and 67.8 % and 69.7 % (p=0.65) at 12 months in sAVG and eAVG groups respectively. As expected, eAVG group patients experienced significantly earlier cannulation when compared with sAVG group patients [median (range): 3.0 (1.0-9.0) versus 19.0 (15.0-22.0) days, p< 0.001].\n\n\nCONCLUSIONS\neAVGs have comparable outcomes to sAVGs at 12 months with the added advantage of earlier time to first cannulation.