Arteriovenous Fistula Maturation Failure in a Large Cohort of Hemodialysis Patients in the Netherlands

Objectives Radiocephalic arteriovenous fistulas (RCAVF) are the preferred vascular access (VA) for hemodialysis (HD). Cohort studies from North America revealed that nonmaturation is a significant disadvantage of RCAVFs compared to other VAs. DESIGN: This present retrospective study describes the in...

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Bibliographic Details
Published in:World journal of surgery 2018-06, Vol.42 (6), p.1895-1903
Main Authors: Voorzaat, Bram M., van der Bogt, Koen E. A., Janmaat, Cynthia J., van Schaik, Jan, Dekker, Friedo W., Rotmans, Joris I.
Format: Article
Language:English
Subjects:
Abdominal Surgery
Cardiac Surgery
Demographics
Demography
Dialysis
Failure
Fistulae
General Surgery
Grafts
Hemodialysis
Mathematical models
Maturation
Medical materials
Medical records
Medicine
Medicine & Public Health
Original Scientific Report
Patients
Prediction models
Regression analysis
Statistical analysis
Surgery
Thoracic Surgery
Vascular diseases
Vascular Surgery
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Summary:Objectives Radiocephalic arteriovenous fistulas (RCAVF) are the preferred vascular access (VA) for hemodialysis (HD). Cohort studies from North America revealed that nonmaturation is a significant disadvantage of RCAVFs compared to other VAs. DESIGN: This present retrospective study describes the incidence of nonmaturation of AVFs and functional failure of arteriovenous grafts (AVG) in a multicentre cohort in the Netherlands and attempts to create a prediction model for nonmaturation of RCAVFs. Furthermore, the efficacy of interventions to promote maturation as well as the variability between hemodialysis centers was evaluated. Materials Medical records from 8 hospitals from 1997 to 2016 were retrospectively evaluated for VA type, maturation/primary success and demographics and comorbidities. Methods A prediction model was created for RCAVF nonmaturation using multivariate logistic regression analysis, selecting significant predictors using backward selection. Discrimination and calibration of the model were assessed. Results 1383 AVFs and 273 AVGs were included in 1221 patients. Overall nonmaturation was 24% for RCAVFs, and 11% for upper arm AVFs. The functional failure rate for AVGs was 6%. The nonmaturation rate of contralateral RCAVFs after failure of an RCAVF was 22%. Procedures to improve RCAVF maturation were successful in 98/142 cases (69%). Predictors for nonmaturation were female gender, peripheral vascular disease, cerebrovascular disease and a cephalic vein diameter
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-017-4382-z