Cardiovascular comorbidity and late referral impact arteriovenous fistula survival: A prospective multicenter study

Autologous arteriovenous fistulas (AVF) have the best 5-yr patency and the lowest complication rate among hemodialysis vascular accesses. However, maturation requirements to optimize survival are unknown. A longitudinal cohort study was conducted to ascertain risk factors for failure, maturation tim...

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Bibliographic Details
Published in:Journal of the American Society of Nephrology 2004, Vol.15 (1), p.204-209
Main Authors: RAVANI, Pietro, BRUNORI, Giuliano, MANDOLFO, Salvatore, CANCARINI, Giovanni, IMBASCIATI, Enrico, MARCELLI, Daniele, MALBERTI, Fabio
Format: Article
Language:English
Subjects:
Aged
Arteriovenous Shunt, Surgical
Biological and medical sciences
Blood and lymphatic vessels
Cardiology. Vascular system
Cardiovascular Diseases - complications
Catheterization
Cohort Studies
Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous
Female
Follow-Up Studies
Humans
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - therapy
Longitudinal Studies
Male
Medical sciences
Prospective Studies
Renal Dialysis - methods
Risk Factors
Survival Analysis
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Summary:Autologous arteriovenous fistulas (AVF) have the best 5-yr patency and the lowest complication rate among hemodialysis vascular accesses. However, maturation requirements to optimize survival are unknown. A longitudinal cohort study was conducted to ascertain risk factors for failure, maturation time, and survival of the first AVF. All patients who initiated hemodialysis between January 1, 1997, and December 31, 2002, in three centers were included in this study. Analysis was restricted to patients who received an AVF. Cox regression was used to estimate the association between predictors of interest and primary and secondary AVF survival. Of the 535 patients enrolled (mean age, 66.5 yr; 57.8% male; 26.7% diabetic), 513 (96%) received an AVF. Patients who initiated with catheters (47%) cannulated their AVF earlier (median maturation period, 0.78 versus 1.80 mo; P < 0.001). Median primary and secondary survivals were longer than 50 and 72 mo, respectively. After adjustment for confounding factors, cardiovascular disease (hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.26 to 2.67), utilization earlier than 1 mo after placement (HR, 1.94; 95% CI, 1.34 to 2.82), and referral within 3 mo of dialysis start (HR, 1.55; 95% CI, 1.04 to 2.32) were associated with a reduction in primary AVF survival. Presence of cardiovascular disease (HR, 2.21; 95% CI, 1.38 to 3.55), maturation time
ISSN:1046-6673
1533-3450
DOI:10.1097/01.asn.0000103870.31606.90