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NDT Advance Access originally published online on November 6, 2006
Nephrology Dialysis Transplantation 2007 22(2):465-470; doi:10.1093/ndt/gfl629
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Arteriovenous access outcomes in haemodialysis patients with HIV infection

Dana Mitchell1, Zipporah Krishnasami1, Carlton J. Young2 and Michael Allon1

1Division of Nephrology and 2Division of Transplant Surgery, University of Alabama at Birmingham, AL 35233, USA

Correspondence and offprint requests to: Michael Allon, MD, Division of Nephrology, PB, Room 226, 728 Richard Arrington Blvd, Birmingham AL 35233, USA. Email: mdallon{at}uab.edu



  Abstract

Background. Arteriovenous (AV) grafts in haemodialysis patients usually fail due to thrombosis or infection. There is limited information on whether graft outcomes in HIV-positive haemodialysis patients differ from those in HIV-negative controls.

Methods. Using a prospective, computerized vascular access database, we identified retrospectively 15 HIV-positive dialysis patients having a graft placed during a 6.5-year period (January 1999 to June 2005), and compared their graft outcomes to those observed in 30 age-, sex- and access date-matched HIV-negative control patients. In addition, the outcomes of AV fistulas in 23 HIV-positive patients were compared with those observed in 32 matched HIV-negative controls.

Results. Thrombosis-free graft survival was substantially worse among the HIV-positive patients than in the HIV-negative controls (1-year survival, 17% vs 62%). The hazard ratio for graft thrombosis in the HIV-positive patients was 3.22 (95% CI, 1.66–10.32, P = 0.002). Infection-free graft survival was also lower in HIV-positive patients (hazard ratio 3.51; 95% CI, 1.21–18.85, P = 0.025). Finally, cumulative graft survival (from creation until permanent failure) tended to be lower in HIV-positive patients (1 year survival, 41% vs 65%, P = 0.07). The primary failure rate of fistulas (those never usable for dialysis) was similar in HIV-positive patients and in their controls (44% vs 41%, P = 0.83). Cumulative fistula survival was similar for HIV-positive and negative patients (hazard ratio 1.32; 95% CI, 0.65–3.58, P = 0.33).

Conclusion. AV grafts have inferior outcomes in HIV-positive patients as compared with HIV-negative patients, whereas fistulas have a similar survival in both groups.

Keywords: fistula; graft; HIV; infection; vascular access


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