Abstract
Background
The main barriers to arterio-venous fistula (AVF) utilization are primary failure, long maturation duration, and low secondary patency rates.
Methods
In this retrospective cohort study, primary, secondary, functional primary, and functional secondary patency rates were calculated and compared between two age groups (< 75 years and > = 75 years) and between radiocephalic (RC-) and upper arm (UA-) AVFs, and factors determining the duration of functional secondary patency were evaluated.
Results
Between 2016 and 2020, 206 predialysis patients whose AVFs had been created previously initiated renal replacement treatment. RC-AVFs comprised 23.3% and were created after favorable analysis of the forearm vasculature. Overall, the primary failure rate was 8.3, and 84.7% started hemodialysis with a functioning AVF. Functional secondary patency rates of primary AVFs were better with RC-AVFs [1,3 and 5 year rates of 95.8, 81.9 and 81.9% versus 83.4, 71.8 and 59.2% for UA-AVFs (log rank p: 0.041)]. There was no difference between the two age groups for any of the AVF outcomes assessed. Among patients whose AVF was abandoned, 40.3% had gone on to have a second fistula created. This was significantly less likely in the older group (p < 0.01). In conclusion: (1) UA-AVFs were placed more commonly than RC-AVFs; (2) a selection bias existed whereby RC-AVFs were only created after favorable forearm vasculature was demonstrated or suspected; (3) superior functional secondary patency rates were observed with RC-AV’s, perhaps stemming from this selection bias; (4) the elderly were more likely to have only one AVF creation attempt.
Similar content being viewed by others
Data availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Gallieni M, Hollenbeck M, Inston N (2019) Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults. Nephrol Dial Transplant 34(2):1–42. https://doi.org/10.1093/ndt/gfz072
Lok CE, Huber TS, Lee T et al (2020) KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis 75(4 2):1–164. https://doi.org/10.1053/j.ajkd.2019.12.001
Mendelssohn DC, Ethier J, Elder SJ, Saran R, Port FK, Pisoni R (2006) Haemodialysis vascular access problems in Canada: results from the dialysis outcomes and practice patterns study (DOPPS II). Nephrol Dial Transplant 21(3):721–728. https://doi.org/10.1093/ndt/gfi281
Lok CE, Sontrop JM, Tomlinson G, Rajan D, Cattral M, Oreopoulos G, Harris J, Moist L (2013) Cumulative patency of contemporary fistulas versus grafts (2000–2010). Clin J Am Soc Nephrol 8(5):810–818. https://doi.org/10.2215/CJN.00730112
Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, Canaud BJ, Pisoni RL (2008) Vascular access use and outcomes: an international perspective from the dialysis outcomes and practice patterns study. Nephrol Dial Transplant 23:3219–3226. https://doi.org/10.1093/ndt/gfn261
Dumaine C, Kiaii M, Miller L, Moist L, Oliver MJ, Lok CE, Hiremath S, MacRae JM (2018) Vascular access practice patterns in canada: a national survey. Can J Kidney Health Dis 28(5):2054358118759675. https://doi.org/10.1177/2054358118759675
Lee T, Mokrzycki M, Moist L, Maya I, Vazquez M, Lok CE (2011) North american vascular access consortium standardized definitions for hemodialysis vascular access. Semin Dial 24(5):515–524
Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M Jr, Miller A, Scher L, Trerotola S, Gregory RT, Rutherford RB, Kent KC (2002) Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg 35(3):603–610. https://doi.org/10.1067/mva.2002.122025
Dember L, Beck G, Allon M et al (2008) Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA 299(18):2164–2171
Li H, Jen S, Ramayya T, Bowers HG, Rotem E (2018) Unanticipated late maturation of an arteriovenous fistula after creation of separate graft access. Quant Imag Med Surg. 8(4):444–446
Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX, Kosa SD, Quinn RR, Moist LM (2014) Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis 63(3):464–478. https://doi.org/10.1053/j.ajkd.2013.08.023
Rooijens P, Tordoir J, Stijnen T, Burgmans J, Smetde A, Yo T (2004) Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Surg 28(6):583–589. https://doi.org/10.1016/j.ejvs.2004.08.014
Huber T, Carter J, Carter R, Seeger J (2003) Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review. J Vasc Surg 38(5):1005–1011. https://doi.org/10.1016/s0741-5214(03)00426-9
Bylsma LC, Gage SM, Reichert H, Dahl SLM, Lawson JH (2017) Arteriovenous fistulae for haemodialysis: a systematic review and meta-analysis of efficacy and safety outcomes. Eur J VascEndovasc Surg 54:513–522. https://doi.org/10.1016/j.ejvs.2017.06.024
Oliver MJ, Quinn RR, Garg AX, Kim SJ, Wald R, Paterson JM (2012) Likelihood of starting dialysis after incident fistula creation. Clin J Am Soc Nephrol 7:466–471. https://doi.org/10.2215/CJN.08920811
Silva MB Jr, Hobson RW, Pappas PJ, Jamil Z, Araki CT, Goldberg MC, Gwertzman G, Padberg FT Jr (1998) A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J Vasc Surg 27:302–307. https://doi.org/10.1016/s0741-5214(98)70360-x
Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN (2007) A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 45(2):420–426. https://doi.org/10.1016/j.jvs.2006.10.035
Palmer SC, Di Micco L, Razavian M, Craig JC, Ravani P, Perkovic V, Tognoni G, Graziano G, Jardine M, Pellegrini F, Nicolucci A, Webster A, Strippoli GF (2013) Antiplatelet therapy to prevent hemodialysis vascular access failure: systematic review and meta-analysis. Am J Kidney Dis 61:112–122. https://doi.org/10.1053/j.ajkd.2012.08.031
Dember LM, Beck GJ, Allon M et al (2008) Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA 299:2164–2171. https://doi.org/10.1001/jama.299.18.2164
Harms JC, Rangarajan S, Young CJ, Barker-Finkel J, Allon M (2016) Outcomes of arteriovenous fistulas and grafts with or without intervention before successful use. J Vasc Surg 64:155–162. https://doi.org/10.1016/j.jvs.2016.02.033
Vachharajani TJ, Moossavi S, Jordan JR, Vachharajani V, Freedman BI, Burkart JM (2011) Re-evaluating the fistula first initiative in octogenarians on hemodialysis. Clin J Am Soc Nephrol 6(7):1663–1667. https://doi.org/10.2215/CJN.05830710
Borzumati M, Funaro L, Mancini E, Resentini V, Baroni A (2013) Survival and complications of arteriovenous fistula dialysis access in an elderly population. J Vasc Access 14(4):330–334. https://doi.org/10.5301/jva.5000143
Tordoir JH, Rooyens P, Dammers R, van der Sande FM, de Haan M, Yo TI (2003) Prospective evaluation of failure modes in autogenous radiocephalic wrist access for hemodialysis. Nephrol Dial Transplant 18(2):378–383
Biuckians A, Scott EC, Meier GH, Panneton JM, Glickman MH (2008) The natural history of autologous fistulas as first-time dialysis access in the KDOQI era. J Vasc Surg 47(2):415–421. https://doi.org/10.1016/j.jvs.2007.10.041
Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A et al (2008) Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA 299:2164–2171. https://doi.org/10.1001/jama.299.18.2164
Pisoni RL, Young EW, Dykstra DM et al (2002) Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int 61:305–316. https://doi.org/10.1046/j.1523-1755.2002.00117.x
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
You, J., Ploszaj, L., Taskapan, H. et al. Functional patency rates of arteriovenous fistula of a retrospective cohort study from one of the biggest centers in Canada. Int Urol Nephrol 55, 2621–2628 (2023). https://doi.org/10.1007/s11255-023-03553-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-023-03553-w