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Kidney Week

Abstract: FR-PO491

Initial Vascular Access Flow Rate for Early Prediction of Need for Intervention: A Retrospective Cohort Study

Session Information

  • Dialysis: Vascular Access
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 803 Dialysis: Vascular Access

Authors

  • Bergmann, Matthias, St Elizabeth's Medical Center, Brighton, Massachusetts, United States
  • Fakhoury, Butros, St Elizabeth's Medical Center, Brighton, Massachusetts, United States
  • Costa, Tiago, St Elizabeth's Medical Center, Brighton, Massachusetts, United States
  • Jaber, Bertrand L., St Elizabeth's Medical Center, Brighton, Massachusetts, United States
  • Balakrishnan, Vaidyanathapuram, St Elizabeth's Medical Center, Brighton, Massachusetts, United States
Background

Arterio-venous fistula (AVF) or graft (AVG) are lifelines for most hemodialysis (HD) patients. Low access flow rate (AFR) often requires intervention to prevent access failure. This study examines if AFR, measured at initial AVF/AVG cannulation, predicts need for intervention in the first year.

Methods

From 2012 to 2021, 52 (30.7%) of 169 patients with surgical AVF/AVG creation had AFR measurements. Up to three values were collected per subject. Need for intervention within one year was documented.

Results

Of 52 subjects, 28 (53.8%) required access intervention. After stratification by need for intervention (data not shown), patient characteristics were not significantly different. However, first AFR was significantly lower in the group with access intervention (898±495 vs. 1471±777mL/min; P=0.003), as was average AFR (841±399 vs. 1506±700mL/min; P<0.001). Receiver-operating characteristic (ROC) curve analyses (Figure1 and Table1) showed that first AFR (area-under-the-curve [AUC] 0.743; 95% CI 0.608, 0.877) and average AFR (AUC 0.775; 95% CI 0.648, 0.903) predicted need for access intervention within one year.

Conclusion

In HD patients, early AFR measurements can predict access intervention within one year after initial access cannulation. Our results are limited by single center setting and small sample size. Further studies are needed to determine optimal AFR cut-offs that indicate AVF/AVG at higher risk of early stenosis.

Figure 1. Receiver operating characteristic (ROC) curve showing diagnostic performance of first and average access flow rates (AFR) in new arterio-venous fistulas (AVF) and grafts (AVG) for predicting need for intervention within one year.

Table 1. Area-under-the-curve (AUC) shows good diagnostic performance of access flow rate (AFR) for predicting patency-assisted intervention within one year.