Gender Based Utilization and Outcomes of Autogenous Fistulas and Prosthetic Grafts for Hemodialysis Access

ABSTRACT Objective To evaluate gender-based patterns of utilization and outcomes of arteriovenous fistulas (AVF) and grafts (AVG) in a population based cohort of hemodialysis (HD) patients. Methods A retrospective analysis of all patients in United States Renal Database System who had an AVF or AVG placed for HD access (01/2007-12/2014). Outcomes were access maturation, conduit patency, infection and mortality. Chi-square, student t-tests, Kaplan-Meier and multivariable Cox regression analyses were employed accordingly. Results There were 456693 (57%) males and 341571 (43%) females who initiated HD via AVF (16%), AVG (4%) and HD-catheter (80%). There was 30% decrease in odds of initiating HD with AVF in females compared to males (aOR: 0.70; 95%CI: 0.69-0.71, P Conclusions Female gender is associated with lower prevalence of preemptive AVF’s, higher utilization of catheters as a bridge to AVF and lower patency compared to males. There was no difference in access maturation but patient survival was higher for females compared to males.