Outcomes of autogenous arteriovenous fistula versus prosthetic arteriovenous graft in adult patients with end-stage renal disease: analysis of the Taiwan National Health Insurance Research Database

Arteriovenous fistulas (AVFs) are the commonly preferred permanent vascular access for hemodialysis. However, differences in long-term outcomes between AVFs and arteriovenous grafts (AVGs) are not well understood. This study aimed to compare patency and outcomes between patients with end-stage renal disease (ESRD) receiving AVFs or AVGs. This retrospective study included adults with ESRD who received an AVF or AVG between 2001 and 2016 from the Taiwan National Health Insurance Research Database. Inverse probability of treatment weighting (IPTW) based on propensity scores was applied to balance baseline characteristics. Restricted mean time lost (RMTL) was used to compare primary and secondary patency failure at 1, 3, and 5 years, while Cox proportional hazards models were used to evaluate mortality and complications at 30 days, 90 days, and 1 year. A total of 8,730 patients were included. After IPTW, baseline characteristics were well balanced between groups. Compared with AVFs, AVGs were associated with greater RMTL due to primary patency failure at 1, 3, and 5 years (differences: 1.00, 4.89, and 8.28 months, respectively; all p < 0.001) and secondary patency failure (0.39, 2.90, and 6.72 months, respectively; all p < 0.001). AVGs were also associated with higher mortality at 30 days (hazards ratio [HR], 2.88; 95% CI, 1.60–5.19), 90 days (HR, 1.56; 95% CI, 1.03–2.36), and 1 year (HR, 1.72; 95% CI, 1.38–2.15). In addition, higher hazards of infection at 30 days (HR, 1.94; 95% CI, 1.17–3.21) and of sepsis (HR, 1.38; 95% CI, 1.04–1.82) and infection (HR, 1.25; 95% CI, 1.02–1.54) at 1 year were observed with AVGs. AVFs were associated with better long-term patency and lower risks of mortality and infectious complications than prosthetic AVGs. These findings support preferential use of AVFs when clinically feasible, while emphasizing individualized vascular access selection. N/A.