Comparison of arteriovenous fistula patency in lipoprotein apheresis and haemodialysis: A matched case-control study.

OBJECTIVE

Arteriovenous fistulas constitute an effective vascular access option for haemodialysis, demonstrating high patency rates and lower infection risk compared with synthetic accesses. Treatment algorithms and patient characteristics differ between haemodialysis and apheresis therapy, and fistula outcomes in patients receiving lipoprotein apheresis have not yet been systematically evaluated.

METHODS

This single-centre, retrospective cohort study compared arteriovenous fistula outcomes in 29 patients receiving lipoprotein apheresis with those of 87 frequency-matched patients on haemodialysis. Matching criteria included age, sex, fistula configuration and diabetes mellitus status. Primary and secondary patency rates and associated risk factors were assessed over a 24-month follow-up period using Kaplan-Meier and Cox regression analysis.

RESULTS

The study included patients with radiocephalic (n = 72) or brachiocephalic (n = 44) arteriovenous fistulas. Indications for apheresis were elevated lipoprotein(a) levels (n = 26) and dyslipoproteinemia (n = 3). Mean age was comparable between groups (61.4 vs 61.2 years), as was the proportion of male patients (58.6% vs 60.9%). Diabetes mellitus was present in 58.6% of apheresis patients and 49.4% of haemodialysis patients. Two-year primary patency rates were comparable between groups (49.2% vs 50.8%), while secondary patency was lower in the apheresis group (59.9% vs 71.1%). In the apheresis cohort, diabetes was associated with reduced primary (HR, 4.034; 95 % CI, 1.10-14.80; p = 0.035) and secondary patency (HR, 9.807; 95 % CI, 1.24-77.59; p = 0.030). Apheresis before fistula creation demonstrated improved secondary patency (HR, 0.198; 95% CI, 0.04-0.94; p = 0.042). In haemodialysis patients, hyperlipoproteinemia was associated with reduced secondary patency (HR, 2.28; 95% CI, 1.01-5.14; p = 0.046).

CONCLUSIONS

Arteriovenous fistula patency in patients undergoing apheresis was comparable to haemodialysis patients despite elevated lipoprotein levels. Diabetes was associated with reduced fistula patency in lipoprotein apheresis. The findings support arteriovenous fistulas as long-term access option and highlight the importance of individualised access planning.