Ultrasound Predicts Successful AVF Maturation in HD

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In a study, arteriovenous fistula blood flow, diameter, and depth were the most informative parameters.
In a study, arteriovenous fistula blood flow, diameter, and depth were the most informative parameters.

Arteriovenous fistula (AVF) blood flow, diameter, and depth, assessed by ultrasound following surgery, accurately predicts AVF maturation, according to new findings published online ahead of print in the Journal of the American Society of Nephrology.

Michelle Robbin, MD, of the University of Alabama at Birmingham, and her colleagues studied ultrasound parameters at 1 day, 2 weeks, and 6 weeks after surgery from 602 patients with newly created AVFs. According to a backward elimination algorithm, AVF blood flow, diameter, and depth anticipated successful maturation, defined as fistula use for 75% of treatments over 4 weeks with adequate blood flow and clearance. The 3 parameters significantly predicted both unassisted and overall AVF maturation at each time point. None of the other variables studied (upper arm arterial diameter, stenosis, or accessory veins) proved as useful. Case-mix factors (age, sex, black race, AVF location, diabetes, dialysis status, and body mass index) also were not associated with outcome.

"If there is a clinical concern about AVF maturation after surgery, a 6-week ultrasound can help the clinician assess the likelihood of AVF maturation," Dr Robbin stated in a news release from the American Society of Nephrology. "If the AVF does not appear ready for dialysis access, management decisions such as the need for AVF intervention or watchful waiting for expected maturation can be aided based on 6-week ultrasound measurements of AVF depth, diameter, and blood flow."

Only single-stage AVFs were assessed in the study, which is a limitation.

In an accompanying editorial, Matthew J. Oliver, MD, MHS, from the University of Toronto, agreed that the findings appear clinically valuable. “Measuring flow, diameter, and depth in the postoperative period as part of routine care now seems reasonable to guide clinicians in decision making.”

References

Robbin ML, Greene T, Allon M, et al. Prediction of arteriovenous fistula clinical maturation from postoperative ultrasound measurements: Findings from the Hemodialysis Fistula Maturation Study. J Am Soc Nephrol. DOI:10.1681/ASN.2017111225

Oliver MJ. The Science of fistula maturation. J Am Soc Nephrol. DOI:10.1681/ASN.2018090922

Ultrasound helps predict the success of fistulas in individual dialysis patients. American Society of Nephrology; October 11, 2018. (news release)

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