Arteriovenous Fistula Maturation Failure in a Large Cohort of Hemodialysis Patients in the Netherlands

Abstract

Objectives Radiocephalic arteriovenous fistulas (RCAVF) are the preferred vascular access (VA) for hemodialysis (HD). Cohort studies from North America revealed that nonmaturation is a significant disadvantage of RCAVFs compared to other VAs. DESIGN: This present retrospective study describes the incidence of nonmaturation of AVFs and functional failure of arteriovenous grafts (AVG) in a multicentre cohort in the Netherlands and attempts to create a prediction model for nonmaturation of RCAVFs. Furthermore, the efficacy of interventions to promote maturation as well as the variability between hemodialysis centers was evaluated. Materials Medical records from 8 hospitals from 1997 to 2016 were retrospectively evaluated for VA type, maturation/ primary success and demographics and comorbidities. Methods A prediction model was created for RCAVF nonmaturation using multivariate logistic regression analysis, selecting significant predictors using backward selection. Discrimination and calibration of the model were assessed. Results 1383 AVFs and 273 AVGs were included in 1221 patients. Overall nonmaturation was 24% for RCAVFs, and 11% for upper arm AVFs. The functional failure rate for AVGs was 6%. The nonmaturation rate of contralateral RCAVFs after failure of an RCAVF was 22%. Procedures to improve RCAVF maturation were successful in 98/142 cases (69%). Predictors for nonmaturation were female gender, peripheral vascular disease, cerebrovascular disease and a cephalic vein diameter \2.5 mm, but the prediction model lacked sensitivity and specificity predicting individual RCAVF nonmaturation (C-statistic 0.629). Conclusion Nonmaturation rates are highest for RCAVFs, but nonmaturation could not be predicted with demographic parameters.

A Randomized Trial of Liposomal Prednisolone (LIPMAT) to Enhance Radiocephalic Fistula Maturation: A Pilot Study

“…The 62% successful cannulation rate observed in the LIPMAT study was comparable to previous studies on functional AVF maturation. 1 , 7 Although the nonsignificant result may be a mere result of a lack of power due to the small sample size, also no trend toward any difference between the treatment and control group was observed. Apart from a lack of statistical power, several factors might explain the lack of therapeutic efficacy of liposomal prednisolone to improve AVF maturation.…”

“…Patients on maintenance hemodialysis (HD) require a reliable vascular access; however, only half of newly created radiocephalic arteriovenous fistulas (RCAVF) can be used for HD without additional procedures to promote maturation and up 25% fail to provide adequate vascular access for HD. 1 The need for subsequent creation of upper arm arteriovenous fistulas (AVFs) and arteriovenous grafts may decrease if maturation can be improved. Currently, no pharmacological treatments have been proven to improve clinical maturation of AVFs.…”

Patency Outcomes of Arteriovenous Fistulas and Grafts for Hemodialysis Access: A Trade-Off between Nonmaturation and Long-Term Complications

“…We have previously reported on the maturation outcomes in a multicenter cohort of patients on HD in The Netherlands (6). The incidence of nonmaturation in our cohort was 24% for radiocephalic arteriovenous fistulas (RCAVFs) and 11% for upper arm AVFs.…”

“…A nonmatured VA was defined as a VA that could not be used successfully for HD or a VA that was abandoned in a patient not yet on HD (6). To standardize patency outcomes, the patency definitions as described by Sidawy et al (7) were used.…”

“…Baseline characteristics are summarized as mean 6 SD for continuous variables and frequency (percentage) for categorical variables. Baseline characteristics are reported only for patients receiving their first VA; those of the entire cohort were reported previously (6). Primary, primary assisted, and functional patency rates are presented as survival analyses using Kaplan-Meier curves with 1-and 3-year patency, expressed as percentage patent 6 SEM.…”