Comorbidities Do not Influence Primary Fistula Success in Incident Hemodialysis Patients

Abstract

Background and objectives: Concern about primary fistula failure may contribute to the underuse of arteriovenous fistula. The objective of this study was to investigate the baseline clinical parameters associated with primary fistula success.Design, setting, participants, & measurements: Consecutive incident patients who commenced dialysis during a 28-mo period in a regional renal program were studied. Data on patient-related variables and on surgical approach (e.g., whether the surgeons routinely assess vessel size during the operation) were collected. Primary fistula success was defined as an arteriovenous fistula that was able to afford successful dialysis for 3 h with blood pump speed of >300 ml/min for three consecutive sessions.Results: A total of 205 (69%) patients had an AVF attempted as their first vascular access. The overall primary success rate was 64% and was similar for radiocephalic and brachiocephalic fistula. Logistic regression was done separately for patients with the two types of fistula because of the presence of statistical interaction. For radiocephalic fistula, male gender was the only parameter associated with primary fistula success (odds ratio 3.57; P ‫؍‬ 0.01). The presence of comorbidity was not significantly associated with primary fistula failure.Conclusions: Despite significant patient comorbidity, there was a high primary fistula success rate among this incident hemodialysis cohort. Given that vessel size may be the ultimate determinant of fistula success, if surgeons assess vessel size perioperatively, then the presence of significant comorbidity might not preclude arteriovenous fistula from being attempted as the initial access.

Outcomes of arteriovenous fistula creation, effect of preoperative vein mapping and predictors of fistula success in incident haemodialysis patients: A single‐centre experience

“…This is consistent with previous studies that did not find a significant difference between patient age and AVF outcome . The presence of comorbidities that may potentially adversely affect the vascular health was not significantly associated with AVF failure, similar to findings by Wang et al . The association of male gender with AVF success has been reported in previous studies .…”

“…The risk of fistula failure appears to be greater among older patients, those with substantial vascular abnormality or medical comorbidities especially diabetes mellitus . However, there is also evidence that vessel size might be the ultimate determinant of fistula success and high maturation rate is achievable despite significant patient comorbidity …”

Fistula use after concurrent arteriovenous fistula formation and Tenckhoff catheter insertion

“…Even when excluding the six patients currently on PD with clinically functioning AVF that have not been used, 30% use of concurrently formed AVF is significantly greater than the 6% reported by Beckingham et al . The rates of primary failure in the concurrently created fistula in our study are also consistent with outcomes seen in recent literature, greater than those seen in the era in which most of the existing evidence was derived . Although this conceivably would weaken the case for concurrent AVF creation, the high rates of PD technique failure and the high risk of damage to native veins over time in a more frail incident dialysis population may mitigate any effect.…”

Can primary failure of arteriovenous fistulas be anticipated?

“…Arteriovenous fistula primary failure rates have also been found to be higher in women, and the fact that women have generally narrower vasculature is thought to be responsible for this association. Higher primary failure rates have been seen in radiocephalic fistulas constructed in female patients . On the contrary, there are studies that did not show an association between gender and AVF failure .…”

“…Higher primary failure rates have been seen in radiocephalic fistulas constructed in female patients. [34][35][36] On the contrary, there are studies that did not show an association between gender and AVF failure. 5,37 We did not detect a statistically significant difference in AVF failure rates between male or female patients.…”