The following article features coverage from the National Kidney Foundation’s 2019 Spring Clinical Meetings. Click here to read more of Renal & Urology News’ conference coverage.

The Kidney Disease Outcomes Quality Initiative (KDOQI) guideline favors creation of a forearm arteriovenous fistula (AVF) over an upper arm AVF in patients requiring hemodialysis (HD). But new research suggests forearm AVFs may fail more and be less patent than upper arm AVF. Ammar Almehmi, MD, of the University of Alabama at Birmingham, and his collaborators presented the new study findings at the National Kidney Foundation’s 2019 Spring Clinical Meetings in Boston.

In a comparison of 121 patients with an upper arm AVF and 165 patients with a forearm AVF, upper arm AVF cases had significantly higher cumulative patency (disregarding the number of interventions): 74% vs 59%, respectively. Furthermore, the odds for access failure were twice as high in forearm AVF cases in multivariate analysis. Women had a significant 58% higher likelihood of AVF failure than men.

The composition of the study population was 39% females and 88% black. In addition, 50% of patients had diabetes, 96% had hypertension, and 28% had congestive heart failure.

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“We speculate that female gender, the small caliber of the blood vessels, and comorbidities such as diabetes could play a role in AVF failure,” Dr Almehmi told Renal & Urology News.

Larger studies are needed to further validate the findings of the current study.

Read more of Renal & Urology News’ coverage of NKF’s 2019 Spring Clinical Meetings by visiting the conference page.


Almehmi A, Al-Balas A, Krishna V, Abdel-Aal AK. Long term cumulative patency rate of forearm versus upper arm arteriovenous fistulas. Presented at the National Kidney Foundation’s 2019 Spring Clinical Meetings in Boston, May 8-12, 2019. Poster 302.