Response to Commentary on “Is There an Accurate Pre-operative Criterion for Dialysis Access Artery or Vein Diameter?”

Abstract

Response to Commentary on "Is There an Accurate Preoperative Criterion for Dialysis Access Artery or Vein Diameter?" We read with great interest the invited commentary by Cook and Padberg 1 on our paper about vascular access patients. 2 Unfortunately the authors incorrectly stated that "It is difficult to determine the functional patency of an AVF placed prior to beginning dialysis, making assumed functionality (maturation), as employed by Kakkos et al., 4 a flawed concept". Actually we wrote "Fistulas were considered functional if they were cannulated for dialysis on six occasions" under outcome measure definition in the methodology section of our article. It is true that in some studies with short-term follow-up there may be an issue with pre-hemodialysis patients who have a late cannulation; however, because our study had long-term follow-up, the actual cannulation status of each patient was known. Therefore we have not used a flawed concept as the authors have mentioned. We expect the upcoming clinical practice guidelines on vascular access of the European Society of Vascular Surgery, 3 and also the update of the KDOQI guidelines, 4 to provide objective and clinically useful definitions of arteriovenous fistula maturation and functionality.