Relationships Between Clinical Processes and Arteriovenous Fistula Cannulation and Maturation: A Multicenter Prospective Cohort Study

Feldman, Harold I.; Dember, Laura M.; Farber, Alik; Kaufman, James S.; Stern, Leonard; Lesage, Pauline; Kivork, C.; Soares, Douglas de Sousa; Malikova, Marina; Allon, Michael; Young, Carlton J.; Taylor, Mark A.; Woodard, L.; Mangadi, K.; Roy‐Chaudhury, Prabir; Munda, Rino; Lee, T.; Alloway, Rita R.; El-Khatib, Mahmoud; Canaan, T.; Pflum, Adam; Thieken, L.; Campos-Naciff, Begona; Huber, Thomas S.; Berceli, Scott A.; Jansen, M.; McCaslin, G.; Trahan, Y.; Vázquez, Miguel A.; Vongpatanasin, Wanpen; Davidson, Ingemar; Hwang, Chin Chang; Lightfoot, T.; Livingston, Charles; Valencia, Ana Lucía; Dolmatch, Bart L.; Fenves, Andrew Z.; Hawkins, Nicky; Cheung, Alfred K.; Kraiss, Larry W.; Kinikini, Daniel V.; Treiman, Gerald S.; Ihnat, Daniel M.; Sarfati, Mark R.; Mueller, Matthias; Lavasani, Iran; Maloney, Michaella E.; Schlotfeldt, L.; Shiu, Yan-Ting; Terry, Christi M.; Himmelfarb, Jonathan; Buchanan, Charlotte; Clark, Christopher J.; Crawford, C.; Hamlett, Jane; Kundzins, John; Manahan, L.; Wise, J.; Beck, Gerald J.; Gassman, Jennifer; Greene, Tom; Imrey, Peter B.; Li, L.; Alster, Joan M.; Li, M.; Mackrell, John; Radeva, Milena; Wiggins, Kathryn J.; Weiss, Brian; Alpers, Charles E.; Hudkins, Kelly L.; Wietecha, Tomasz; Robbin, Michelle L.; Umphrey, Heidi; Alexander, Lauren; Abts, C.; Belt, L.; Vita, Joseph A.; Hamburg, Naomi M.; Duess, Mai‐Ann; Левит, А Л; Higgins, H. William; Ke, Seiffert; Mandaci, O.; Snell, Christopher R.; Gravley, J.; Behnken, S.; Mortensen, Rikke Nørmark; Chertow, Glenn M.; Besarab, Anatole; Brayman, Kenneth L.; Diener‐West, Marie; Harrison, Donald L.; Inker, Lesley A.; Louis, T.; McClellan, William; Rubin, Jeffrey R.; Kusek, John W.; Star, Robert A.

doi:10.1053/j.ajkd.2017.10.027

Cited by 63 publications

(58 citation statements)

References 24 publications

(23 reference statements)

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“…For patients not receiving dialysis at the time of AVF creation surgery, and initiating dialysis therapy .9 months later, the first dialysis session in the 4 week period meeting the stipulated pump flow, Kt/V, or URR criterion was required to be within 4 weeks of hemodialysis therapy initiation. 26 AVF clinical maturation was defined as unassisted when not preceded by a percutaneous or surgical intervention to promote maturation, and otherwise as assisted. Overall maturation was defined as AVF clinical maturation with or without a prior intervention.…”

Section: Avf Clinical Maturationmentioning

confidence: 99%

Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study

Robbin¹,

Greene²,

Allon

et al. 2018

JASN

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125

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Background The utility of early postoperative ultrasound measurements in predicting arteriovenous fistula (AVF) clinical maturation is uncertain. Methods We investigated the relationships of ultrasound parameters with AVF clinical maturation in newly created AVF, measured at 1 day and 2 and 6 weeks, in 602 participants of a multicenter, observational cohort study. A backward elimination algorithm identified ultrasound measurements that independently predicted unassisted and overall AVF maturation. Candidate variables included AVF blood flow, diameter, and depth, upper arm arterial diameter, presence of stenosis, presence of accessory veins, seven case-mix factors (age, sex, black race, AVF location, diabetes, dialysis status, and body mass index), and clinical center. We evaluated the accuracy of the resulting models for clinical prediction. Results At each ultrasound measurement time, AVF blood flow, diameter, and depth each predicted in a statistically significant manner both unassisted and overall clinical maturation. Moreover, neither the remaining ultrasound parameters nor case-mix factors were associated with clinical AVF maturation after accounting for blood flow, diameter, and depth, although maturation probabilities differed among clinical centers before and after accounting for these parameters. The crossvalidated area under the receiver operating characteristic curve for models constructed using these three ultrasound parameters was 0.69, 0.74, and 0.79 at 1 day and 2 and 6 weeks, respectively, for unassisted AVF clinical maturation and 0.69, 0.71, and 0.76, respectively, for overall AVF maturation. Conclusions AVF blood flow, diameter, and depth moderately predicted unassisted and overall AVF clinical maturation. The other factors considered did not further improve AVF maturation prediction.

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Section: Avf Clinical Maturationmentioning

confidence: 99%

Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study

Robbin¹,

Greene²,

Allon

et al. 2018

JASN

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125

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“…Vascular access function is the most frequently reported vascular access outcome but is very heterogeneous with almost 900 measures used to assess the usability and function of an access 5 More than a third of participants were unable to use their study AVF for dialysis by 6 months after access creation. This is comparable to the national average of AVF use of 36% in prevalent HD patients of the US 182 and 39% reported in the US Haemodialysis Fistula Maturation study 183 . Of note, in the North American study investigating the effect of clopidogrel on early fistula thrombosis and dialysis suitability failure 72 , 61% of participants were unable to use their fistula reliably for HD.…”

Section: Discussionsupporting

confidence: 74%

“…These observations reflect differences in case-mix, care processes, AVF complications (e.g. infiltrations), and AVF procedures 183 and are not expected to be influenced by fish oil or aspirin use.…”

Section: Discussionmentioning

confidence: 76%

“…Results from the Haemodialysis Fistula Maturation (HFM) study are expected to advance our understanding of anatomical, biological and clinical characteristics, as well as processes of care associated with enhanced AVF usability254 . This study has recruited 602 patients undergoing single-stage AVF surgery in the US and already provided information on clinical and post-operative processes of care predictors of AVF maturation255,256 . Assessment of pre-operative vessel characteristics, anaesthetic (e.g.…”

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confidence: 99%

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Strategies to improve vascular access outcomes in haemodialysis patients

Viecelli¹

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It is estimated that over 3 million people worldwide are currently treated for end-stage kidney disease, with most receiving haemodialysis (HD). A functioning vascular access (VA) provides a lifeline for patients requiring HD but VA dysfunction remains one of the leading causes of excessive morbidity, mortality and healthcare costs in this group. Despite increasing numbers of VA trials, successful interventions to improve VA outcomes have been sparse and compromised by highly variable, often selectively reported outcomes of limited relevance to patients and health professionals.This thesis aimed to establish strategies to improve VA outcomes by 1) determining whether fish oil or aspirin is effective in improving outcomes of newly created arteriovenous fistulas (AVFs); and, 2) establishing a standardised core outcome measure for VA based on the shared priorities of patients and health professionals to improve the consistency, reliability and relevance of VA research in HD.Aim 1 was addressed with an international, double-blind, randomised, placebo-controlled trial entitled, "omega-3 fatty acids (Fish oils) and Aspirin in Vascular access OUtcomes in REnal Disease" (FAVOURED). It included 567 adult participants planned for AVF creation who were randomised to fish oil (4g/d) or placebo. Of these, 406 participants were also randomised to aspirin (100mg/d) or placebo. Treatment started 1 day pre-surgery and was continued for 12 weeks. The primary outcome was AVF failure (a composite of thrombosis and/or abandonment and/or cannulation failure) at 12 months. Secondary outcomes included the primary outcome components, AVF interventions, and central venous catheter (CVC) requirement. The FAVOURED study revealed that 12 weeks of fish oil did not reduce the proportion of AVF failure compared to placebo (47% versus 47%, relative risk [RR] adjusted for aspirin use 1.03, 95% confidence interval [CI] 0.86-1.23) or its outcome components. Low-dose aspirin was similarly ineffective. However, fish oil was effective in reducing AVF intervention rates (0.82 vs 1.14 interventions/1000 patient-days, incident rate ratio [IRR] 0.72, 95% CI 0.54-0.97), driven by a significant relative reduction in rescue interventions for thrombosis by 47%. Similarly, low-dose aspirin significantly reduced V Publications included in this thesis 1. Viecelli AK, Mori TA, Roy-Chaudhury P, Polkinghorne KR, Hawley CM, Johnson DW, Pascoe EM, Irish AB. The pathogenesis of hemodialysis vascular access failure and systemic XIII 9. Viecelli AK, Pascoe EM, Hawley CM, Polkinghorne KP, Mori TA, Johnson DW, Irish AB for the Omega-3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) Study Collaborative Group. Effects of fish oil and aspirin use on arteriovenous fistula, patency, need for interventions and dialysis suitability in patients requiring haemodialysispost hoc analysis of the FAVOURED study. Nephrol Dial Transplant. 2017;32 (S3):iii65.

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“…The causes of these relatively high rates of access abandonment merit further scrutiny. A complex set of process of care parameters and clinical complications have recently been shown to be associated with access maturation [14]. A similar set of process of care issues (pre-op management, e.g.,) and clinical events (thromboses, e.g.,) may also be found to be linked with access abandonment in prospective studies.…”

Section: Discussionmentioning

confidence: 97%

Clinical Outcomes of Arteriovenous Access in Incident Hemodialysis Patients with Medicare Coverage, 2012–2014

et al. 2019

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Background: Chronic hemodialysis requires a mode of vascular access through an arteriovenous fistula (AVF), a prosthetic arteriovenous graft (AVG), or a central venous catheter (CVC). AVF is recommended over AVG or CVC due to increased patency and decreased intervention rates for those that mature. AVG are preferred over CVC due to decreased infection and mortality risk. The aims of this study were to evaluate the lifespan of AVF and AVG in maturation, sustained access use, and abandonment. Methods: The United States Renal Data System (USRDS), Medicare claims, and CROWNWeb were used to identify access placements. Patients with a first end-stage renal disease (ESRD) service from January 1, 2012 to June 30, 2014 with continuous coverage with Medicare as primary payer and ≥1 AVF or AVG placed after ESRD onset were included. Maturation was defined as the first use of the access for hemodialysis recorded in CROWNWeb. Sustained access use was defined as 3 consecutive months of use without catheter placement or replacement. Accesses that were never used at any time post-placement were considered abandoned. Results: The cohort included 38,035 AVF placements and 12,789 AVG placements. Sixty-nine percent of AVF and 72% of AVG matured. Fifty-two percent of AVF and 51% of AVG achieved sustained access use. One quarter of AVF and 14% of AVG were abandoned without use as recorded in CROWNWeb. Conclusion: Although considered the gold standard for vascular access, only half of AVF and AVG placements achieved sustained access use. The USRDS database has inherent limitations but provides useful clinical insight into maturation, sustained use, and abandonment.

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Relationships Between Clinical Processes and Arteriovenous Fistula Cannulation and Maturation: A Multicenter Prospective Cohort Study

Abstract: Multiple processes of care and complications are associated with AVF maturation outcomes.

Cited by 63 publications

References 24 publications

Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study

Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study

Strategies to improve vascular access outcomes in haemodialysis patients

Clinical Outcomes of Arteriovenous Access in Incident Hemodialysis Patients with Medicare Coverage, 2012–2014

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