Arteriovenous fistula (AVF) dysfunction in patients on hemodialysis (HD) occurs more often in older adults, women, and patients with high platelet counts, severe anemia, or longer retention of a temporary catheter, according to new study findings.
Guochun Chen, MD, and colleagues from the Second Xiangya Hospital in China studied 100 HD patients from their institution receiving a first AVF placement. To minimize the influence of secondary factors, only patients with idiopathic glomerular disease (free of diabetes, hypertension, etc.) were selected and all underwent surgery by the same team.
AVF dysfunction (defined as blood flow of 200 mL/min or less during dialysis) occurred in 27 patients due to impatency, according to results published in Blood Purification. A total of 84%, 73%, and 72% of AVFs survived for 6, 12, and 24 months, respectively.
AVF failure commonly occurred in women and the elderly. AVF dysfunction occurred significantly more in patients with elevated platelet levels, severe anemia (less than 8 g/dL), or extended temporary catheter retention (more than 60 days). A multivariate Cox regression analysis confirmed these variables as independent risk factors for a first AVF dysfunction.
The investigators also reported that other measured factors had no bearing on results, including body mass index, serum albumin, serum calcium, serum phosphorus, prothrombin time, and activated partial thromboplastin time.
“In conclusion, this clinical study suggests that primary AVF failure is strongly associated with a number of risk factors, raising the possibility that intervention strategies targeting these potential influences in ESRD [end-stage renal disease] patients may improve the long-term success of AVF placement,” Dr Chen and the team concluded.
The team noted that high hemoglobin levels might also be associated with AVF failure, so anemia treatment should be cautious. In addition, anticoagulant treatments barely improved AVF survival.
Wen M, Li Z, Li J, et al. Risk factors for primary arteriovenous fistula dysfunction in hemodialysis patients: A retrospective survival analysis in multiple medical centers. Blood Purif. doi:10.1159/000500045