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Abstract: TH-PO261

Novel Method to Monitor Arteriovenous Fistula Maturation: Impact on Catheter Residence Time

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access

Authors

  • Rosales, Laura, Renal Research Institute, New York, New York, United States
  • Ye, Xiaoling, Renal Research Institute, New York, New York, United States
  • Zhang, Hanjie, Renal Research Institute, New York, New York, United States
  • Chan, Brenda Kim, Renal Research Institute, New York, New York, United States
  • Mateo, Marilou, Renal Research Institute, New York, New York, United States
  • Johnson, Seth, Renal Research Institute, New York, New York, United States
  • Kotanko, Peter, Renal Research Institute, New York, New York, United States
Background

Timely assessment of arterio-venous fistula (AVF) maturation is essential to reduce the residence time of central venous catheters (CVC). We used central-venous oxygen saturation (ScvO2) and estimated upper-body blood flow (eUBBF) to monitor AVF maturation. We now report CVC residence time in patients with and without ScvO2-based AVF maturation monitoring.

Methods

Newly created AVF were monitored employing ScvO2-based AVF maturation during a clinical quality improvement project (QIP) conducted in two Renal Research Institute (RRI) clinics (QIP clinics). ScvO2 was measured by Crit-Line (Fresenius Medical Care, Waltham, MA); eUBBF was computed as reported [Rosales (2019), doi: 10.1159/000494742]. Time-to-event analysis compared CVC residence time post-AVF creation between QIP and three non-QIP control groups (CG). CG 1: concurrent controls from 2 non-QIP RRI clinics (N=134 patients); CG 2: concurrent controls from the 2 QIP RRI clinics (N=48); CG 3: historic (2014-6) pre-QIP controls from the 2 QIP RRI clinics (N=57). Censoring events were death, dialytic modality change, transplantation, lost to follow up, and end of observation period (Nov. 2021).

Results

The QIP group comprised 44 patients (age 59 ±17 years; 27 males). The 4 groups did not differ regarding age, race, and sex. Six months after AVF creation, the fraction of patients with CVC still in place was 21% in the QIP group; CG 1 58%; CG 2 67%; CG 3 68%. The Kaplan-Maier curved differed significantly between groups (P<0.0001, log rank test. Fig 1).

Conclusion

Compared to three control groups, CVC residence time was shorter in patients with ScvO2-based assessment of AVF maturation. Tracking of ScvO2 and eUBBF is a non-invasive means to follow AVF maturation, trigger timely interventions, and shorten CVC residence time.

Figure 1: Catheter residence time after AVF creation. ScvO2-based monitoring of AVF maturation (QIP; red); concurrent control (4 RRI clinics; green); concurrent controls (2 QIP clinics; cyan); historic controls (QIP clinics; purple).