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Kidney Week

Abstract: TH-PO333

Performance Characteristics of Criteria for Hemodialysis Arteriovenous Fistula Clinical Maturation

Session Information

  • Vascular Access - I
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Ng, Jia Hwei, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Yang, Wei, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Kobrin, Sidney M., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Dember, Laura M., University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background

A barrier to conducting and interpreting clinical studies of interventions for improving fistula outcomes is the lack of standardized and readily ascertainable criteria for defining fistula maturation. Using data from the multicenter, prospective NIDDK Hemodialysis Fistula Maturation (HFM) study, we determined performance characteristics of more readily ascertainable alternatives to the HFM clinical maturation criteria.

Methods

We included the 544 participants for whom clinical maturation was ascertained during the HFM study. The HFM criteria for maturation required fistula use for ≥75% of dialysis sessions within any 4-week period with either a) dialysis machine blood pump speed ≥300 ml/min or b) spKt/V ≥1.4. The criteria had to be met within 9 months of fistula creation or 8 weeks of dialysis initiation, whichever was later. For the current analysis, we developed alternative maturation criteria that incorporated one or more of the following domains: 1) # of sessions of fistula use, 2) dialysis machine blood pump speed, 3) small solute clearance, 4) no use of an alternative access, and 5) time from fistula creation.

Results

Mean age was 56 years, 69% were men, 45% were Black, and 64% had diabetes. 396 (72%) had successful fistula maturation (either assisted or unassisted) by HFM criteria. Performance characteristics of our alternative criteria are shown in the Table. All criteria had high specificity (93-100%), but criteria that require only 3 months for ascertainment had low sensitivity (36-67%).

Conclusion

Several alternatives to the HFM maturation outcome that are easier to ascertain have high predictive utility and, thus, could potentially simplify the conduct of research studies. However, an ascertainment period that extends beyond 3 months after fistula creation is required for adequate sensitivity.

Funding

  • NIDDK Support