Predictors of Sustained Arteriovenous Access Use for Haemodialysis

Abstract

Background: Guidelines encourage early arteriovenous (AV) fistula (AVF) planning for haemodialysis (HD). The aim of this study was to estimate the likelihood of sustained AV access use taking into account age, sex, comorbidity, anatomical site of first AVF and, for pre-dialysis patients, eGFR and proteinuria. Methods: 1,092 patients attending our centre who had AVF as their first AV access procedure between January 1, 2000 and August 23, 2012 were identified from the electronic patient record. The primary end-point was time to first sustained AV access use, defined as use of any AV access for a minimum of 30 consecutive HD sessions. Results: 52.9% (n = 578) of the patients ultimately achieved sustained AV access use. The main reasons for AV access non-use were AVF failure to mature and death. The 3-year Kaplan-Meier probability of sustained AV access use was 68.8% for those not on renal replacement therapy (RRT) (n = 688) and 74.2% for those already on RRT (n = 404) at the time of first AVF. By multivariate analysis in patients not on RRT, male sex (HR 2.22; p < 0.001), uPCR (HR 1.03; p = 0.03) and eGFR (hazard ratio, HR 0.85; p < 0.001) were independent predictors of AV access use. In patients already on RRT, age (HR 0.98; p < 0.001) and peripheral vascular disease (HR 0.48; p = 0.02) were independent predictors of AV access use. Conclusion: Our data suggest that refinement of the current guideline for timing of AV access creation in planning RRT is justified to take into account individual factors that contribute to the likelihood of technical success and clinical need.

Arteriovenous Fistulae for Haemodialysis: A Systematic Review and Meta-analysis of Efficacy and Safety Outcomes

“…Additionally, one of the three studies included in the 6 month rate analysis only included patients that had one previously failed access, 17 and another included a unique maturation definition. 16 Clarity of reporting is paramount to understanding the true value of AVF as an access modality. The challenges of inconsistent or unclear outcomes terminology underscore the importance of applying a consistent set of definitions and nomenclature for specific fields.…”

Investigating clinical predictors of arteriovenous fistula functional patency in a European cohort

“…Multiple studies have investigated clinical predictors of FTM with no general consensus [ 15 , 19 – 21 ]. In our population of 525 patients, female gender and lower-arm AVF site were the only predictors of AVF FTM.…”

Impact of Poverty and Health Care Insurance on Arteriovenous Fistula Use among Incident Hemodialysis Patients

“…Variables with p < 0.10 in unadjusted analysis were introduced into multivariate analysis as covariates because of the possibility of negative confounding. Also, our model development used 'forced' entry to account for factors known to be clinically associated with the outcome variable, based on existing literature [8,26,27] .…”

“…Because AVF require several weeks to mature and approximately 40% of created AVF never mature [4] , AVF creation is reliant on predialysis care, especially predialysis nephrology referral [5][6][7] . While studies of the development and maturation of AVF have focused on clinical factors [8][9][10][11] , the role of socioeconomic factors, particularly individual-level poverty, has not been reported in a recent national cohort of dialysis patients, although a previous study reported that county-level poverty was inversely associated with incident AVF use, but not with subsequent improvement in AVF use in prevalent patients [12] . We have previously reported that AVF use in new HD patients is significantly higher among patients in the federal health system (e.g.…”