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- Title
Arteriovenous Fistula Maturation, Functional Patency, and Intervention Rates.
- Authors
Huber, Thomas S.; Berceli, Scott A.; Scali, Salvatore T.; Neal, Dan; Anderson, Erik M.; Allon, Michael; Cheung, Alfred K.; Dember, Laura M.; Himmelfarb, Jonathan; Roy-Chaudhury, Prabir; Vazquez, Miguel A.; Alpers, Charles E.; Robbin, Michelle L.; Imrey, Peter B.; Beck, Gerald J.; Farber, Alik M.; Kaufman, James S.; Kraiss, Larry W.; Vongpatanasin, Wanpen; Kusek, John W.
- Abstract
<bold>Importance: </bold>National initiatives have emphasized the use of autogenous arteriovenous fistulas (AVFs) for hemodialysis, but their purported benefits have been questioned.<bold>Objective: </bold>To examine AVF usability, longer-term functional patency, and remedial procedures to facilitate maturation, manage complications, or maintain patency in the Hemodialysis Fistula Maturation (HFM) Study.<bold>Design, Setting, and Participants: </bold>The HFM Study was a multicenter (n = 7) prospective National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases cohort study performed to identify factors associated with AVF maturation. A total of 602 participants were enrolled (dialysis, kidney failure: 380; predialysis, chronic kidney disease [CKD]: 222) with AVF maturation ascertained for 535 (kidney failure, 353; CKD, 182) participants.<bold>Interventions: </bold>All clinical decisions regarding AVF management were deferred to the individual centers, but remedial interventions were discouraged within 6 weeks of creation.<bold>Main Outcomes and Measures: </bold>In this case series analysis, the primary outcome was unassisted maturation. Functional patency, freedom from intervention, and participant survival were summarized using Kaplan-Meier analysis.<bold>Results: </bold>Most participants evaluated (n = 535) were men (372 [69.5%]) and had diabetes (311 [58.1%]); mean (SD) age was 54.6 (13.6) years. Almost two-thirds of the AVFs created (342 of 535 [64%]) were in the upper arm. The AVF maturation rates for the kidney failure vs CKD participants were 29% vs 10% at 3 months, 67% vs 38% at 6 months, and 76% vs 58% at 12 months. Several participants with kidney failure (133 [37.7%]) and CKD (63 [34.6%]) underwent interventions to facilitate maturation or manage complications before maturation. The median time from access creation to maturation was 115 days (interquartile range [IQR], 86-171 days) but differed by initial indication (CKD, 170 days; IQR, 113-269 days; kidney failure, 105 days; IQR, 81-137 days). The functional patency for the AVFs that matured at 1 year was 87% (95% CI, 83.2%-90.2%) and at 2 years, 75% (95% CI, 69.7%-79.7%), and there was no significant difference for those receiving interventions before maturation. Almost half (188 [47.5%]) of the AVFs that matured had further intervention to maintain patency or treat complications.<bold>Conclusions and Relevance: </bold>The findings of this study suggest that AVF remains an accepted hemodialysis access option, although both its maturation and continued use require a moderate number of interventions to maintain patency and treat the associated complications.
- Subjects
VASCULAR resistance; SURGICAL arteriovenous shunts; RESEARCH funding; HEMODIALYSIS; LONGITUDINAL method
- Publication
JAMA Surgery, 2021, Vol 156, Issue 12, p1111
- ISSN
2168-6254
- Publication type
journal article
- DOI
10.1001/jamasurg.2021.4527