التفاصيل البيبلوغرافية
| العنوان: |
Autogenous versus prosthetic vascular access for hemodialysis: A systematic review and meta-analysis. |
| المؤلفون: |
Murad, M. Hassan, Elamin, Mohamed B., Sidawy, Anton N., Malaga, German, Rizvi, Adnan Z., Flynn, David N., Casey, Edward T., McCausland, Finnian R., McGrath, Martina M., Vo, Danny H., El-Zoghby, Ziad, Duncan, Audra A., Tracz, Michal J., Erwin, Patricia J., Montori, Victor M. |
| المصدر: |
Journal of Vascular Surgery; Nov2008, Vol. 48 Issue 5, pS34-S47, 0p |
| مصطلحات موضوعية: |
HEMODIALYSIS, VASCULAR surgery, PROSTHETICS, AUTOTRANSPLANTATION, META-analysis, SURGICAL arteriovenous shunts, CLINICAL trials |
| مصطلحات جغرافية: |
UNITED States |
| مستخلص: |
Objectives: The autogenous arteriovenous access for chronic hemodialysis is recommended over the prosthetic access because of its longer lifespan. However, more than half of the United States dialysis patients receive a prosthetic access. We conducted a systematic review to summarize the best available evidence comparing the two accesses types in terms of patient-important outcomes. Methods: We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science and SCOPUS) and included randomized controlled trials and controlled cohort studies. We pooled data for each outcome using a random effects model to estimate the relative risk (RR) and its associated 95% confidence interval (CI). We estimated inconsistency caused by true differences between studies using the I2 statistic. Results: Eighty-three studies, of which 80 were nonrandomized, met eligibility criteria. Compared with the prosthetic access, the autogenous access was associated with a significant reduction in the risk of death (RR, 0.76; 95% CI, 0.67-0.86; I2 = 48%, 27 studies) and access infection (RR, 0.18; 95% CI, 0.11-0.31; I2 = 93%, 43 studies), and a nonsignificant reduction in the risk of postoperative complications (hematoma, bleeding, pseudoaneurysm and steal syndrome, RR 0.73; 95% CI, 0.48-1.16; I2 = 65%, 31 studies) and length of hospitalization (pooled weighted mean difference –3.8 days; 95% CI, –7.8 to 0.2; P = .06). The autogenous access also had better primary and secondary patency at 12 and 36 months. Conclusion: Low-quality evidence from inconsistent studies with limited protection against bias shows that autogenous access for chronic hemodialysis is superior to prosthetic access. [Copyright &y& Elsevier] |
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