Evaluation of Rate and Time to Arteriovenous Fistula Maturation in Hemodialysis Patients

Abstract

The acceptance rate of hemodialysis (HD) in end stage renal disease (ESRD) patients has been increasing globally. Pakistan is a CKD high burden country with the increasing acceptance rate of HD. Unfortunately, there is dearth of published information regarding the rate, time to and factors associated with AVF maturation. The current retrospective cohort study was conducted with the aim to evaluate the rate, time to and factors associated with delayed AVF maturation. This study was conducted at the HD unit of Baluchistan Institute of Nephrology-Urology Quetta, Pakistan. The record of 120 HD patients who underwent native arteriovenous fistula (AVF) creation was reviewed focusing on the associated factors and arteriovenous fistula maturity. A standardized data collection form was used to abstract patients’ socio-demographic and clinical data. Delayed AVF maturation was defined as AVF which got mature after six weeks of its creation. Statistical Package for Social Sciences (SPSS version 20) was used for data analysis. Categorical data was presented at frequencies and percentages whereas, continuous data was presented as mean ± standard deviations. Chi-square and Fisher exact tests wherever applicable were conducted to find association between patients’ socio-demographic and clinical characteristics and delayed AVF maturation. A p-value <0.05 was considered statistically significant. Mean age and body mass index of the study participants were respectively 43.20 ±15.184 years and 20.14 ± 4.37 kg/m2. Majority of them were males (53.3%), belonged the age group 31-45 years (42.5%), rural residents (62.5%) and non-smokers (65.8%). A total of 93.3% patients were suffering from hypertension and 6.7% suffered from diabetes mellitus. Majority of the study participants had no family history of CKD (81.7%) and baseline visit of dialysis they had CKD duration of 2-5 years (47.5%). The mean time to AVF maturation in the current cohort was 41.9 ± 8.5 days. A total of 91.7% patients achieved the early maturation of AVF. No factor had statistical significant association with delayed AVF maturation. The rate of AVF maturation in the current cohort is comparatively high than reported in the published literature. Being a single centre study with retrospective design its results cannot be generalized. In the current study, 91.5% of the patients achieved early maturation of AVF. The rate of early maturation in the current cohort was comparatively higher than that reported in the previously published literature. In this retrospective study, we didn’t find out any factor which had significant association with time to AVF maturation.