#1703 Role of early AV fistula creation among elderly and its impact on estimated decline in GFR among pre dialysis patients

Abstract

Abstract Background and Aims Recent evidence suggests that AVF creation may slow estimated glomerular filtration rate (eGFR) decline. The aim of the present study was to assess the impact of the pre dialysis AVF creation on eGFR decline and the need for dialysis, after controlling for key confounding factors among elderly population with advanced renal failure . Method A retrospective cohort study among patients attending Nephrology, Urology and General Surgery OPD between Jan 2019-Jan 2022 in Tertiary care hospital, Lucknow for AV fistula creation and assessed their stage of CKD and trajectory of fall in eGFR within a year's time and the time to initiation of dialysis from AV fistula creation was assessed. Results 34 men and 23 females (> 65 years ) of age who at time of AV fistula creation had an median eGFR at time of AVF creation of 15.5 (10.3–16.9) mL/min/1.73m2. The factors like frailty, diabetes, psychosocial issues were matched between the two genders . Males were more in age with better BMI .Baseline eGFRs were 14.4± 2.0 mL/min/1.73m2 in men and 13.8.0 ± 1.2 mL/min/1.73m2 in women. The crude annual eGFR decline rates were − 3.20 ± 2.50 mL/min/1.73 m2 pre- and − 2.45 ± 2.16 mL/min/1.73 m2 post-AVF. In a mixed effect linear regression model, monthly eGFR decline was − 0.43 mL/min/1.73m2/month.. The period after AVF creation was associated with a relatively higher eGFR . There was a significant association between follow-up time and the period pre/post AVF such that eGFR decline was more attenuated each month after AVF creation. There was better preservation of GFR from the pre AV fistula creation . Conclusion In this cohort, AVF creation was associated with a significant reduction of eGFR decline among elderly population . Further prospective studies are needed to confirm this association