Abstract: TH-PO263
Long-Term Hemodialysis Access Survival of Arteriovenous Fistulas
Session Information
- Vascular Access: From Biology to Managing Complications
November 03, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 703 Dialysis: Vascular Access
Authors
- Cerqueira, Tiago Lemos, Hospital Evangelico, Belo Horizonte, Minas Gerais, Brazil
- Pimenta, Isabela Lage, Hospital Evangelico, Belo Horizonte, Minas Gerais, Brazil
- Oliveira, Roberto Lazzarini, Hospital Evangelico, Belo Horizonte, Minas Gerais, Brazil
- Palotti, Mayra Martins, Hospital Evangelico, Belo Horizonte, Minas Gerais, Brazil
- Barros, Tamires Oliveira, Hospital Evangelico, Belo Horizonte, Minas Gerais, Brazil
Background
Vascular access is crucial for patients with End Stage Kidney Disease (ESKD) who choose hemodialysis (HD). Arteriovenous fistula (AVF) is the preferred type for its lowest risk of complications and mortality. Thus, it is important to consider AVF longevity when planning for a vascular access. We aim to compare three AVFs – radiocephalic (RC), brachiocephalic (BC) and brachiobasilic (BB) – regarding their access survival to guide shared-decision making of the most appropriate vascular access for our patients.
Methods
This is a 4 dialysis centers' retrospective cohort of patients on HD who had their AVF created between April 2014 and September 2018 in Minas Gerais, Brazil. Follow-up was until March 2021. We conducted a survival analysis comparing RC, BC and BB AVFs by Kaplan-Meyer curve and Cox-regression, controlling for age, gender, cause of ESKD, previous catheter on the AVF side and previously failed AVF history. When proportional hazards were not met, Cox-Regression with time-dependent covariate was done. Censoring: loss to follow-up, leaving HD modality or death. Software used: IBM® SPSS Statistics 23.
Results
789 AVFs were included in the study: 28% (220) RC, 38% BC (304) and 34% (265) BB. 56% were male with 58±13.5 years of age. Common causes of ESKD were diabetic (40%), hypertensive (22%) and glomerular (8%) nephropathies. 63% had a previous catheter on the AVF side, while 49% had a previously failed AVF. 220 (28%) had early AVF failure after surgery. Median time to successful maturation was 10 weeks for RC and BC and 9 weeks for BB. Median follow-up time was 108 weeks.
In the uncontrolled analysis, we found no differences in access survival between RC and BC AVFs (p = 0.3). RC had better survival after 30 weeks than BB (p = 0.02, HR = 1.2, 95% CI 1.02-1.48) and BC was also better than BB after 7 weeks (p = 0.00, HR = 1.5, 95% CI 1.13-1.97). After controlling for confounders, we found that RC became worse than BB (p = 0.00, HR = 0.8, 95% CI 0.68-0.93) before 30 weeks, but had similar survival after that period. BC remained better than BB (p = 0.03, HR = 1.35, 95% CI 1.02-1.77) after 7 weeks. Surprisingly, RC became worse than BC (p = 0.46, HR = 0.78, 95% CI 0.61-0.99).
Conclusion
Patient characteristics influece AVF survival in several ways. BC AVFs appear to have the longest access survival after cofounder control.
Funding
- Private Foundation Support