Yang Jin Park, Shin Suk Yang, Keun Myung Park, Dong-Ik Kim, Young-Wook Kim
Samsung Medical Center, Seoul, Republic of Korea.
OBJECTIVES: To find predictors that affect initial autogenous hemodialysis access maturation
METHODS: All patients undergoing autogenous hemodialysis access creation from August 2008 to December 2010 were retrospectively reviewed. We investigated type of fistula, maturation rates based on patients’ clinical characteristics and findings on physical examination and preoperative DUS mapping studies. The following factors were analyzed: age, gender, body-mass index (BMI), diabetes, hypertension, hyperlipidemia, congestive heart failure (CHF), coronary artery disease (CAD), cerebrovascular disease (CVD), ejection fraction (EF, %), preoperative DUS artery and vein size, prior central catheter placement.
RESULTS: Three-hundred eighty-three vascular access procedures were performed in 371 patients. Three-hundred thirty-one (86.4%) were autogenous AVF, among which a primary first AVF was created in 283 (85.5%); 186 (65.7%) with radiocephalic AVF (RCAVF), 95 (33.6%) with brachiocephalic AVF (BCAVF), 2 (0.7%) with basilic vein transposition (BVT). All patients underwent preoperative DUS mapping for artery and vein sizing. RCAVF, BCAVF, BVT had 88.2%, 82.1%, 100% maturation rates in mean 39 days after creation. By univariate analysis, diabetes, CAD and vein diameter were associated with maturation rates, but there was no significant factor by multivariate analysis. In RCAVF (n=186), CHF (p =0.041), minimal forearm CV (CV min) size (p =0.007), mean forearm CV (CV mean) size (p =0.013), and CV min over 2 mm (p =0.002) significantly affected maturation by univariate analysis. By multivariate logistic regression analysis, CV min over 2mm (p=0.001) and non-diabetes (p=0.046) were independent predictor of RCAVF maturation.
CONCLUSIONS: In RCAVF, high ejection fraction, non-diabetes, CV min over 2 mm were independent predictors of primary maturation. Preoperative DUS would be recommended to encourage the use of native AVF and to promote its maturation rate.
AUTHOR DISCLOSURES: D. Kim, Nothing to disclose; Y. Kim, Nothing to disclose; K. Park, Nothing to disclose; Y. Park, Nothing to disclose; S. Yang, Nothing to disclose.
Posted April 2012