Abstract
McDermott et al. recognize infections as the most serious and common complication of vascular access (VA) for hemodialysis (HD) or peritoneal dialysis (PD) treatment, with subsequently higher costs for these renal replacement modalities compared with renal transplantation.1Letter to Editor re Cost-effectiveness of vascular access for haemodialysis: arteriovenous fistulas versus arteriovenous grafts.Eur J Vasc Endovasc Surg. 2013 Jan; 45: 84-92Abstract Full Text Full Text PDF PubMed Google Scholar This may be true for patients with HD through central vein catheters, but certainly not for patients receiving either PD or HD through arteriovenous fistulae (AVF) or arteriovenous grafts (AVG). Several publications have shown similar outcome in terms of morbidity, hospital admission and death as a result of infectious complications in patients on PD or HD with an AVF or AVG as vascular access.2Perl J. Wald R. McFarlane P. Bargman J.M. Vonesh E. Na Y. et al.Hemodialysis vascular access modifies the association between dialysis modality and survival.J Am Soc Nephrol. 2011; 22: 1113-1121Crossref PubMed Scopus (226) Google Scholar, 3Ocak G. Halbesma N. le Cessie S. Hoogeveen E.K. van Dijk S. Kooman J. et al.Haemodialysis catheters increase mortality as compared to arteriovenous accesses especially in elderly patients.Nephrol Dial Transplant. 2011; 26: 2611-2617Crossref PubMed Scopus (57) Google Scholar The purpose of our study was to compare all costs necessary to establish and maintain VA through an AVF or AVG. This not only includes costs for treatment of infection, but also in particular costs for access maintenance and revision, like endovascular and/or surgical interventions, to establish long-term patency.4Leermakers J.J. Bode A.S. Vaidya A. van der Sande F.M. Evers S.M. Tordoir J.H. Cost-effectiveness of vascular access for haemodialysis: arteriovenous fistulas versus arteriovenous grafts.Eur J Vasc Endovasc Surg. 2013; 45: 84-92Abstract Full Text Full Text PDF PubMed Scopus (50) Google Scholar We do agree that renal transplantation is the ultimate goal to treat young patients, in particular, with chronic renal failure and as in many centers, living-related kidney transplantation is in our center a well-established method for these patient groups. But one should keep in mind that nowadays most patients in HD programs are very old with multiple comorbidities, with a contra indication for renal transplantation. These old patients, who are usually not on the waiting list for transplantation, may certainly benefit from an AVF, which, in addition, incurs lower healthcare costs to main access patency in comparison with the use of AVGs. Comparing renal transplantation with the outcome of AVF and AVG as HD vascular access, was not the purpose of our study. Re. ‘Cost-effectiveness of Vascular Access for Haemodialyis: Arteriovenous Fistulas Versus Arteriovenous Grafts’European Journal of Vascular and Endovascular SurgeryVol. 46Issue 1PreviewWe read with interest the paper of Leermakers et al.1 We propose that rather than comparing the cost-effectiveness of arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) the real question is: What is the most cost-effective way to provide safe renal replacement therapy (RRT) to patients with end-stage renal disease (ESRD)? Full-Text PDF Open Archive
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