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Abstract: PO1018

Arteriovenous Fistula Non-Maturation: Does the Immune System Play a Role?

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Farrington, Crystal A., The University of Alabama at Birmingham Department of Medicine, Birmingham, Alabama, United States
  • Cutter, Gary R., The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, United States
  • Allon, Michael, The University of Alabama at Birmingham Department of Medicine, Birmingham, Alabama, United States
Background

Arteriovenous fistula (AVF) non-maturation is a persistent problem, particularly among female and Black patients. The immune system promotes several vascular disease processes, but its contribution to AVF non-maturation has not been well-studied. We evaluated the association of serum panel reactive antibodies (PRA), a measure of immune system reactivity assessed in patients undergoing kidney transplant evaluation, with AVF non-maturation.

Methods

We identified 132 patients at our institution who underwent surgical AVF creation between 2010-2019 and had PRA testing within one year of AVF creation. Multivariable logistic regression was used to determine the association of patient demographic, clinical, and vascular factors with AVF maturation. Receiver operator characteristic (ROC) curves were generated to determine the predictive value of key variables on AVF non-maturation.

Results

AVF non-maturation was more common in females than males (44% vs 20%, p=0.003) and in Black than white patients (40% vs 13%, p=0.001). Class II PRA was higher in females than males (12% +/- 23% vs 4% +/- 13%, p=0.02), but did not differ by race. In the multivariable model, AVF non-maturation was associated with class II PRA (adjusted odds ratio [aOR] 1.34 per absolute 10% increase; 95% confidence interval [CI], 1.04 to 1.82, p=0.02) and Black race (aOR 3.34; 95% CI, 1.02 to 10.89, p=0.03). An ROC curve using seven key variables (Table 1 and Figure 1) showed an area under the curve of 0.73 (95% CI, 0.63 to 0.82, p<0.0001)

Conclusion

The novel association of elevated class II PRA with AVF non-maturation suggests a role for the immune system in AVF maturation outcomes, especially for female patients.

Table 1. AOR of 7 key variables for AVF non-maturation.

Figure 1. ROC curves.