Early Follow-Up after Arteriovenous Fistula Creation is Associated with Improved Access-Related Outcomes

Abstract

Up to 60% of arteriovenous fistulas (AVF) require intervention to assist maturation, which prolongs the time until it can be used for hemodialysis (HD). Current guidelines recommend early postoperative AVF examination to detect and address immaturity to decrease time to maturation. This study evaluates how the timing of postoperative follow-up to assess AVF maturity affects patients' outcomes. All patients who underwent AVF creation between 2017 and 2021 in an academic medical center were retrospectively reviewed, excluding patients lost to follow-up or not on HD. Outcomes were compared between patients that had delayed follow-up to assess AVF maturity, >8 weeks post-surgery, versus early follow-up, <8 weeks post-surgery. AVF evaluation for maturity consisted of physical exam and duplex ultrasound. Primary endpoints were time to first cannulation (interval from AVF creation to first successful cannulation) and time to catheter-free dialysis (interval from AVF creation to central venous catheter removal). A total of 400 patients were identified: 111 in the delayed follow-up group and 289 in the early follow-up group. The median time to follow-up was 78 days (IQR 66-125) in the delayed follow-up group vs. 39 days (IQR 36-47) in the early follow-up group, (p<0.0001). The maturation rate was 87% in the delayed follow-up group vs. 81% in the early follow-up group, (p=0.1) and both groups had similar rates of interventions to assist maturation (66% vs. 57%, p=0.2). The early follow-up group had a significantly shorter median time to first cannulation (50 vs. 88 days, p<0.0001) and shorter time to catheter-free HD (75 vs. 118 days, <0.0001). At 4 months after AVF creation, the incidence of first cannulation was 74% in the early follow-up group vs 63% in the delayed follow-up group (p=0.001). Similarly, the incidence of catheter-free dialysis was 65% in the early follow-up group vs. 50% in the delayed follow-up group at 4 months postoperatively, (p = 0.036). Early post-operative follow up for evaluation of fistula maturation with is associated with reduced time to first successful cannulation of AVF for hemodialysis, and reduced time to catheter-free dialysis.