Nomogram-Based Prediction of the Risk of AVF Maturation :A Retrospective Study

Abstract

Objective: Early identification of autogenous arteriovenous fistula (AVF) maturation failure among end stage renal disease (ESRD) is crucial since it will likely allow early intervention to improve AVF maturation rate and shorten the duration of catheter usage. The aim of this study was to develop a nomogram for predicting AVF maturity in ESRD patients and explore the optimal timing of intervention for promaturity. Methods: In this retrospective study, we assembled a retrospective cohort of 543 ESRD patients who had undergone AVF creation and routine follow-up at the Beijing Haidian Hospital (Haidian Section of Pecking University Third Hospital) between August 2018-and March 2022. A total of 532 subjects were randomly divided into the training cohort (389 cases) and the validation cohort (143 cases). In each cohort, the patients were divided into mature and non-mature groups according to whether arrived clinical or ultrasound criteria on three months after AVF creation. The timing of early intervention for non-maturation AVF was preliminarily discussed after a risk prediction nomogram for non-maturation in newly AVF creation was constructed. Results: Among the total of 532 patients included, 379 (73.24%) of whom achieved fistula maturation at 3 months postoperatively. We randomly divided the total study population using computer-generated randomization into a training cohort (n=389) and a validation cohort (n=143) in approximately a 7:3 ratio. For the training cohort, our study found that the anastomotic diameter (anas1), internal diameter of the anastomotic vein(V1), and brachial artery blood flow (F1) at 1 month postoperatively were associated with the maturity. We generated a maturation nomogram in the training cohort (area under the curve [AUC], 0.938 [95% confidence interval {CI}, 0.908-0.967]; sensitivity 0.911; specificity 0.856) and validated the model in the validation cohort (AUC, 0.927 [95% CI,0.879-0.975]; sensitivity 0.870; specificity 0.886). The calibration curve showed optimal agreement between nomogram prediction and actual observation. Conclusion: The nomogram can help clinicians identify the arteriovenous AVF maturation in ESRD patients. Our research also suggests that one month may be the optimal timing of non-maturity intervention for AVF.