Abstract: TH-PO262
Predictors of Arteriovenous Fistula Maturation
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
- Barros, Tamires Oliveira, Hospital Evangelico, Belo Horizonte, Minas Gerais, Brazil
- Pimenta, Isabela Lage, Hospital Evangelico, Belo Horizonte, Minas Gerais, Brazil
- Palotti, Mayra Martins, Hospital Evangelico, Belo Horizonte, Minas Gerais, Brazil
- Oliveira, Roberto Lazzarini, Hospital Evangelico, Belo Horizonte, Minas Gerais, Brazil
Background
89% of patients with End Stage Kidney Disease (ESKD) choose hemodialysis (HD) as kidney replacement modality, which requires a vascular access. Arteriovenous fistula (AVF) is the preferred access for its lowest risk of complications, despite high chances of failure. We aim to find predictors of AVF maturation after creation based on HD patient’s clinical and vascular mapping (VM) characteristics.
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. The follow-up period was 1 year. Demographic, medical history and VM data were extracted from electronic health records. The primary outcome was to achieve fistula used successfully for hemodialysis (FUSH) criteria. A univariate analysis and a multivariate logistic regression were conducted to find clinical variables that were independent predictors of FUSH. Software: IBM® SPSS Statistics 23.
Results
789 AVFs created were included. 569 (72%) achieved FUSH, while 220 (28%) failed. On univariate analysis, AVF failure was associated with female (p = 0.01), diabetes as ESKD cause (p > 0.01), higher Charlson Index (p > 0.01), lower albumin levels (p = 0.03), and less use of ARB/ACE inhibitor (p > 0.01). In the logistic regression, positively independent predictors of FUSH were: male (OR 1.46, 95% IC 1.05-2.04, p = 0.03); ESKD cause – compared to diabetic nephropathy, hypertensive or glomerular nephropathy (respectively, OR 5.44, 95% IC 2.22-13.33, p > 0.01; OR 1.68, 95% IC 1.08-2.62, p = 0.02); ARB/ACE inhibitor use (OR 1.89, 95% IC 1.36-2.65, p > 0.01), an increase in albumin (OR 1.45, 95% IC 1.04-2.01, p = 0.03) and phosphate levels (OR 1.11; 95% IC 1.00-1.23, p = 0.04); AVF type - brachobasilic was more likely to mature than radiocephalic (OR 1.86, 95% CI 1.18-2.94, p = 0.01) and an increase in the standardized vein diameter (OR 1.53, 95% IC 1.25-1.87, p > 0.01). Having a prior failed AVF was a negative predictor of FUSH (OR 0.69, 95% IC 0.49-0.98, p = 0.04). The two most important variables for the model were primary cause of CKD, followed by the type of AVF and vein diameter.
Conclusion
We found clinical and VM variables that are independent predictors of FUSH, which will aid the development of an AVF maturation score to help vascular access decision-making for patients with ESKD on HD.
Funding
- Private Foundation Support