Determinants of patency of arteriovenous fistula in hemodialysis patients

Abstract

The arteriovenous fistula (AVF) is the vascular access of the first choice for hemodialysis (HD). Studies on patency of AVF and its affecting factors reveal a high risk for access failure. The aim of this study was to assess the primary and secondary AVF patency and their determinant factors. It was a retrospective, descriptive study conducted in the HD facility of the Nephrology Department in Rabta University Hospital. We included AVF created before December 2009 in end-stage renal disease (ESRD) patients. The end of the follow-up was fixed in December 2013. We included 126 AVFs created in 111 patients; 22.5% were aged >65 years, 39.6% were diabetic, 68.5% were hypertensive, and 26.1% had peripheral vascular disease. The primary patency rates were 78% at one year and 42% at five years. The secondary patency rates were 80% at one year and 69% at five years. Multivariate analysis revealed that the factors affecting the primary patency of AVF were: the use of jugular catheter for longer than three months (odds ratio (OR):1.91, P = 0.044) and a C-reactive protein >5 mg/L (OR: 1.7, P = 0.049). Aging (>65 years) (OR: 2.46, P = 0.042), referral time to a nephrologist <6 months before onset of ESRD (OR: 2.87, P = 0.015), absence of an antiplatelet therapy (OR: 4.47, P = 0.005), and serum phosphorus <45 mg/L (OR: 2.07, P = 0.045) were the significant impairing risk factors for secondary AVF patency. Our study suggests that early referral and creation of AVF and maturation before ESRD as well as its adequate monitoring are essential for maintaining patency.

Comparison of Brachiobasilic Transposition Arteriovenous Fistula Outcomes among Diabetic and Non-diabetic Patients: A Case Controlled Study

“…Zouaghi et al evaluated 126 AVFs for its patency and its determinant factors, 39.6% were diabetics in that cohort, only 18 (14.3%) had BBT-AVF; diabetes did not come as a risk factor for poor patency. 6 Higher frequency of steal syndrome in diabetics may also be due more elderly (having advance atherosclerosis) and female (having smaller vessel diameter) patients in this cohort. Limited patency in diabetics can be due to advance atherosclerosis and poor vessel remodeling, which is expected in these patients.…”

The survival analysis of tunnel-cuffed central venous catheter versus arteriovenous hemodialysis access among elderly patients: A retrospective single center study

“…Therefore, the optimal option of hemodialysis vascular access for these patients requires appropriate strategies concerning comorbidities such as frailty, geriatric syndrome, and life expectancy [ 16 ]. The previous studies demonstrated high mortality rates in elderly hemodialysis patients using CVC compared with AVF and AVG [ [11] , [12] , [13] , [17] , [18] , [19] , [20] , [21] ]. Our study's mortality rate was 12.9 per 100 person-year, which was similar to Rivara et al [ 22 ]; this reflected the standard of care in our center.…”

Comprehensive Approach to Improve Quality of Life in Hemodialysis Patients by Early Creation of Arteriovenous Access

“…Catheter-related bloodstream infections (BSIs) alone have a reported incidence of 1.1 to 5.5 episodes per 1000 catheter days and are associated with increased morbidity, hospitalization, and death.1 Barriers to increasing arteriovenous fistula (AVF) creation prompt the initiation of this project; Inadequate pre-ESRD care. A nephrologist often sees ESRD patients for the first time immediately before initiating long-term dialysis (29). In these cases, a PTFE graft often is constructed to avoid the 4-to 6-month maturation time required for an AV fistula.…”

“…Inadequate pre-ESRD care. A nephrologist often sees ESRD patients for the first time immediately before initiating long-term dialysis (29). In these cases, a PTFE graft often is constructed to avoid the 4-to 6-month maturation time required for an AV fistula.…”