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Chung EY, Knagge D, Cheung S, Sun J, Heath L, McColl H, Guo H, Gray L, Srivastava T, Sandy J, McGinn S, Fisher C. Factors associated with functional arteriovenous fistula at hemodialysis start and arteriovenous fistula non-use in a single-center cohort. J Vasc Access 2021; 23:558-566. [PMID: 33752497 DOI: 10.1177/11297298211002574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The gold standard of commencing hemodialysis with a functional arteriovenous fistula (AVF) is challenging. We aim to review factors associated with functional AVF at hemodialysis start at a tertiary hospital. METHODS We retrospectively reviewed incident hemodialysis patients or who had AVF creation at a single tertiary hospital from 2011 to 2016. Data was extracted for patient comorbidities, duration from referral to AVF creation and hemodialysis start, estimated glomerular filtration rate (eGFR) at surgical referral, referring nephrologist, events accelerating eGFR decline, and revisions for "failing to mature" AVF to assess factors associated with non-functioning AVF or late AVF creation, using multinomial logistic regression. RESULTS Two hundred two patients received hemodialysis and 51 had AVF creation but did not dialyze (AVF futility rate 20%). Of these, 133 (66%) commenced hemodialysis with a central venous catheter (CVC) and 69 (34%) with an AVF. Patients with functional AVFs at hemodialysis start were referred earlier than those with non-functional AVFs (median 256 vs 66 days before hemodialysis start, p = 0.001). Age, sex, eGFR at surgical referral, and comorbidities were not predictive of patients with functional AVFs. Events accelerating eGFR decline were associated with an increased incidence of CVC at hemodialysis start (risk ratio (RR) 4.21, 95% confidence interval (CI) 1.96-9.03, p < 0.0001). Referring nephrologists external to our renal unit may be associated with non-functional AVF at hemodialysis start (RR 6.60, 95% CI 1.74-25.13, p = 0.006). CONCLUSIONS We found that functional AVFs required referral a median of 256 days prior to hemodialysis start and events accelerating eGFR decline increase the incidence of CVC at hemodialysis start. Age, sex, eGFR at surgical referral, and comorbidities did not inform the likelihood of timely AVF creation and evaluation of further predictive pre-dialysis factors is necessary to identify patients requiring early AVF creation whilst minimizing the cost of unnecessary procedures.
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Affiliation(s)
- Edmund Ym Chung
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.,Northern Sydney Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Debbie Knagge
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Simone Cheung
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jessica Sun
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lauren Heath
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Hayden McColl
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Henry Guo
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lauren Gray
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Tarini Srivastava
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Joshua Sandy
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Stella McGinn
- Department of Renal Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Charles Fisher
- Department of Vascular Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
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