Electronic Thesis and Dissertation Repository


Master of Science


Epidemiology and Biostatistics


Dr. Louise Moist


Advantages of fistulas, which include long patency and low complication rates, were ascertained over two decades ago and may not apply to the contemporary dialysis population. We conducted a systematic review to summarize the patency and complication rates of fistulas from literature published after 1999. We screened 7,008 citations and 62 articles met our criteria. The risk of primary failure was 27% (95% confidence interval (CI): 23–32%). When primary failures were included, the primary and secondary patency rates were 59% (CI 53–64%) and 66% (CI 58–74%) at one year, respectively. The median rates of infection, ischemic steal syndrome, and thrombosis were 0.11 (range 0.01–1.0), 0.05 (range 0.0–0.1), and 0.27 (range 0.04–0.68) events per 1000 patient-days. When considering the fistula as the preferred option, the initial high risk of primary failure and complication rates should be considered alongside the long-term benefits of using this access.