ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: FR-PO485

Analysis of the Arteriovenous (AV) Fistula Maturation in Eastern North Carolina and Validation of the Failure to Mature Equation

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

  • Kavcar, Akil Serdar, East Carolina University Brody School of Medicine, Greenville, North Carolina, United States
  • Myers, Iskra, East Carolina University, Greenville, North Carolina, United States
Background

AVF is the preferred vascular access for hemodialysis patients but has a high maturation failure rate. Lok et al developed a clinical prediction tool to identify AVFs at risk for Failure to Mature (FTM) and it has achieved good prediction accuracy. We aim to examine the AVF success rate at 6 months and validate the FTM equation in patients with AVF in Eastern North Carolina.

Methods

The retrospective cohort study was done to identify patients who received AVF as their first HD access from 12/01/2009 to 12/01/2020. The primary outcome was AVF failed to mature. The FTM equation risk score was retrospectively applied to our patient cohort and compared with the observed clinical outcomes using Receiver Operating Characteristic (ROC) curve. Univariate and multivariate logistic regression analyses were used to assess the association between the clinical predictors and AVF maturation. A nomogram was developed based on the regression coefficients from the multivariable model, and the weight (point) was given based on the regression coefficient.

Results

A total of 162 patients were found; the mean age was 55 years(SD:13.3), 41% were females, and 89% were African American. The failure to maturation rate at 6 months was 53.5%. Compared to the FTM cohort, there were statistically significant differences in age, ethnicity, BMI, presence of diabetes, CAD, and PVD(p<0.05). Univariate logistic regression showed PVD was associated with increased arteriovenous fistula failure (OR = 2.07; 95% CI = 1.05–4.09; p < 0.05). When results were adjusted for confounders on multivariate analysis odds ratio was 1.8 with a p-value of 0.08 (CI 0.91-3.8). The failure to maturation equation failed to predict maturation outcomes with the area under the curve performance of 0.587. We also developed a different scoring system by using coefficiency values of Hypertension, PVD, and CAD, calculated with multivariate analysis but AUC on the ROC was 0.63 with the new scoring system.

Conclusion

The failure to mature equation failed to predict fistula maturation failure in our cohort. The difference in characteristics between cohorts is the likely reason. PVD was shown to be significantly associated with fistula failure in univariate analysis but when adjusted for other variables it was no longer significant. Analysis for the rest of the clinical factors did not show any significance.