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Abstract: TH-PO412

Attenuation of Estimated Glomerular Filtration Rate Decline After Arteriovenous Fistula Creation in Pre-Dialysis

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Dupuis, Marie-Eve, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Laurin, Louis-Philippe, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Elftouh, Naoual, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Pichette, Vincent, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Goupil, Remi, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
  • Lafrance, Jean-Philippe, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  • Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
Background

Arteriovenous fistula (AVF) placement has been associated with potential attenuation of eGFR decline. Uncertainty remained as to whether this association is specifically related to AVF or rather involves confounding such as natural change in eGFR decline. We sought to assess CKD-EPI eGFR changes before and after AFV creation using a comparator group of peritoneal dialysis (PD) oriented patients.

Methods

This observational study included incident patients followed in a CKD clinic between 2000 and 2017. Patients with AVF placement were matched 1:1 (using age, sex, race, diabetes and eGFR) with patients who underwent PD catheter installation. Time zero/match-point was defined by AVF creation date (AVF group) or date when eGFR was closest to their ‘AVF-pair’ eGFR at time of AVF creation (PD-matched group). Mixed effect linear regression models were built to predict eGFR in the AVF and PD-matched groups. Estimated-GFRs were calculated using the CKD-EPI equation.

Results

Baseline characteristics of the 47 patients with AVF and 47 patients with PD catheter installation were globally similar. Median eGFR at time of AVF creation was 11.4 ml/min/1.73m2 (and 11.9 ml/min/1.73m2 in matched PD group). Predicted eGFR decreased by 0.4 ml/min per month in both groups. There was an attenuation in eGFR decline each additional month after AVF creation/match-point (B 0.23, p<0.001 AVF group, B 0.13, p<0.001 PD matched group). However, the period after AVF creation (or match-point) was associated with a fixed increase in predicted eGFR only for the AVF group (B 1.01, p<0.001).

Conclusion

In this matched cohort study, placement of AVF was associated with an increase in predicted eGFR in the AVF group only. There was however, an attenuation of monthly eGFR decline in both groups with progression of advanced CKD. Overall, this study supports other findings suggesting a contribution of AVF in the stabilisation of eGFR decline.