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Abstract: TH-PO264

Retrospective Analysis Comparing Atrioventricular Fistula Successful Use Rates for Hemodialysis (FUSH) at 6 Months to Prediction by Lok Failure-to-Mature Tool

Session Information

Category: Dialysis

  • 703 Dialysis: Vascular Access


  • Alfarra, Rashed, East Carolina University, Greenville, North Carolina, United States
  • Myers, Iskra, East Carolina University, Greenville, North Carolina, United States
  • Parker, Joseph C., East Carolina University, Greenville, North Carolina, United States

Atrioventricular fistula (AVF) is the preferred vascular access for dialysis patients. AVFs have high non-maturation rate. Lok et al, developed a clinical prediction tool to identify AVFs at risk for Failure To Mature (FTM). The equation includes patient’s age, race, presence of peripheral vascular disease (PVD), coronary artery disease (CAD), and has achieved good prediction accuracy with 69% failure rate in the highest risk category. We aimed to validate the Lok's FTM equation in our patients at East Carolina dialysis unit.


Retrospective chart review identified 43 patients who received AVF from 12/01/2009 to 12/01/2020 at ECU dialysis unit. Demographic and clinical data was obtained from electronic medical records. The primary outcome was AV FUSH at 6 months. The FTM equation risk score was retrospectively applied to our patient cohort and compared with the observed clinical outcomes using Receiver Operating Characteristic in SPSS v28.


In total 43 AVFs were created during the study period. Mean age was 55 +/- 20 years, 89% were African American, 30% of the patients had CAD, 14% had PVD. FUSH at 6 months was 53.5%. We examined the external validity of Lok's model by applying it to our population. 22% of patients with lowest risk score had non maturation at 6 months. 14% of the patients with highest risk scores all lost access within one year of AVF creation despite having FUSH at 6 months.


Despite increased number of AVF creations since Fistula First Initiative, outcomes on maturation rates are suboptimal. Reasonable FUSH rates at 6 months can be achieved. FTM equation was not validated in our cohort. Possible reason is our population cohort (mostly African American) vs Lok's FTM cohort (mostly Caucasian population).