Intervention is commonly required to foster maturation of arteriovenous fistulas (AVFs), maintain patency, and treat complications, a new study finds.
In the prospective, multicenter Hemodialysis Fistula Maturation cohort study, AVF maturation rates among 380 patients with kidney failure were 29%, 67%, and 76% at 3, 6, and 12 months, respectively. Among 535 patients with nondialysis chronic kidney disease (CKD), AVF maturation rates were expectedly lower at 10%, 38%, and 58% at the respective time points. Median time to maturation was 105 days for the kidney failure group and 170 days for the CKD group. Sixty-four percent of all AVFs were created in the upper arm, most commonly using the brachial/ulnar/radial-cephalic configuration.
In the kidney failure and CKD groups, 37.7% and 34.6%, respectively, required interventions to foster maturation or manage complications before maturation, Thomas S. Huber, MD, PhD, of the University of Florida College of Medicine in Gainesville, and colleagues reported in JAMA Surgery. AVF stenosis was the most common reason for intervention in both the kidney failure (26.3%) and CKD (22.5%) groups. The kidney failure group required a tunneled dialysis catheter for a mean 2.9 months before access ascertainment. Approximately one-third of patients required hospitalization before AVF was usable: 37.7% of the kidney failure group and 33.5% of the CKD group.
The functional patency for all of the AVFs that matured at 1 year was 87% and at 2 years, 75%, Dr Huber’s team reported. Patency rates were not affected by intervention.
The investigators found that 47.5% of the AVFs that matured required further intervention to maintain patency or treat complications. The top reasons for intervention were AVF stenosis (38.6%), central vein stenosis (14.6%), and thrombosis (13.4%). More than half of patients in both groups required hospitalization. Overall survival rates for the kidney failure and CKD groups were 92% vs 84% at 12 months, 74% vs 97% at 24 months, and 85% vs 76% at 36 months, respectively.
“The AVF functional patency following maturation was reasonable, with a 2-year rate of 75%, but almost half of the study participants underwent some type of intervention to maintain use,” Dr Huber’s team concluded. “The associated participant morbidity in terms of [tunneled dialysis catheter] use, inpatient hospitalizations, and mortality was substantial.”
Huber TS, Berceli SA, Scali ST, et al. Arteriovenous fistula maturation, functional patency, and intervention rates. JAMA Surg. Published online September 22, 2021. doi:10.1001/jamasurg.2021.4527