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Study observes AVF maturation across some ESRD networks
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Substantial differences in arteriovenous fistula maturation were seen across some end-stage renal disease networks, according to a study published in the American Journal of Kidney Disease. The research highlighted a need for additional study of provider, practice and regional factors that explain arteriovenous fistula maturation.
In a nonconcurrent observational cohort study, researchers identified numerous associations between arteriovenous fistula (AVF) maturation and patient-level factors in a national sample of U.S. patients on hemodialysis. Rates of AVF use among prevalent dialysis patients in the United States more than doubled, from 32% to 65%, between 2003 and 2014.
Although AVFs are the preferred form of hemodialysis vascular access, maturation failures occur frequently and often result in prolonged catheter use, according to the study. Between Jan. 1, 2013 and Dec. 31, 2014, 45,087 new AVFs were placed in 39,820 patients on hemodialysis. Researchers found that no evidence of use was identified for 36.2% of AVFs and 54.7% of AVFs were used within 4 months of placement. Maturation rates varied considerably across ERSD networks.
The study found that a mean of 1.13 AVFs were placed per patient, with 79.5% of patients contributing one AVF; 17.8% contributing two AVFs; and 2.7% contributing three or more AVFs.
“Diabetic and hypertensive kidney disease were the most commonly assigned primary causes of ESRD in the study population,” the researchers wrote.
Older age, female sex, black race, certain comorbid conditions, dialysis vintage longer than 1 year, and catheter or arteriovenous graft use at ESRD incidence were all associated with lower rates or maturation. Hypertension and prior AVF placement at ESRD incidence were associated with greater rates of successful AVF maturation.
Disclosures: Please see the full study for a list of all other authors’ relevant financial disclosures.
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