Predictors of arteriovenous fistula maturation in hemodialysis patients: a prospective cohort from an ambulatory surgical center in Joinville, Brazil

Abstract

Introduction: The high rate of arteriovenous fistula maturation failure is a concern in a scenario of growing numbers of patients on hemodialysis. Non-vascular factors tied to maturation success have not been fully discussed. Methods: This prospective observational cohort study included patients with CKD on dialysis or pre-dialysis prescribed arteriovenous fistula creation for the first time in an ambulatory surgical center in Joinville, Brazil, from January 2021 to July 2021. Anthropometric aspects, sociodemographic characteristics, comorbidities, and vascular parameters observed in Doppler ultrasound were analyzed. Variables associated with maturation were analyzed in multivariate models by logistic regression. Results: Eighty-eight of 145 participants (60.1%) were males. Included patients had a median age of 59 years. Successful arteriovenous fistula maturation occurred in 113 (77.9%) patients. Factors such as increased BMI, hematocrit, arm circumference, and skinfold thickness were associated with lower chances of arteriovenous fistula maturation in univariate analysis. On the other hand, larger vein and artery diameter and fistulas in the more proximal portion of the arm were associated with higher maturation success. In multivariate analysis, smoking and larger skinfold and arm circumference were associated with lower chances of successful maturation. Increased systolic blood pressure and vein diameter were associated with greater chance of success. Conclusion: In addition to the vascular parameters assessed in Doppler ultrasonography, factors related to obesity and/or nutritional aspects may influence arteriovenous fistula maturation.

Maturação de fístulas arteriovenosas: preditores de maturação e uso da ultrassonografia

“…Nesta edição do BJN, Gasparin et al 2 , em um ensaio prospectivo observacional, buscaram avaliar a associação de fatores clínicos e ultrassonográficos com a maturação das FAV criadas em um centro cirúrgico ambulatorial. A maturação em 4 a 6 semanas, definida por diâmetro venoso acima de 0,40 cm e volume fluxo acima de 500 mL/min ao Doppler, foi de 77,9%.…”

“…Os autores sugerem que esse algoritmo poderia ser implementado diretamente nos aparelhos de US, sem tempo adicional para o cálculo 10 . Isso ainda poderia corrigir o viés interobservadores que Gasparin et al 2 consideram existir em exames de mapeamento venoso ultrassonográfico.…”

Arteriovenous fistulas maturation: predictors of maturation and use of ultrasound

“…The authors suggest that this algorithm could be implemented directly in the US devices, without requiring additional time for the calculation 10 . This could even correct the interobserver bias that Gasparin et al 2 consider existing in ultrasound venous mapping tests.…”

“…In this issue of the BJN, Gasparin et al 2 , in a prospective observational trial, sought to assess the association of clinical and sonographic factors with the maturation of AVF created in an outpatient surgical center. Maturation in 4 to 6 weeks, defined by venous diameter greater than 0.40 cm and flow volume greater than 500 mL/min on Doppler, was 77.9%.…”