Abstract
BackgroundArteriovenous fistula (AVF) is the vascular access of choice for patients on hemodialysis. Recent evidence suggests that AVF creation may slow estimated glomerular filtration rate (eGFR) decline. The study objective was to assess the impact of the AVF creation on eGFR decline, after controlling for key confounding factors.MethodsThis retrospective cohort study included adult patients followed in a single-center predialysis clinic between 1999 and 2016. Patients with a patent AVF were followed up to 2 years pre- and post-AVF creation. Estimated GFR trajectory was reported using linear mixed models adjusted for demographic characteristics, comorbidities and use of renin-angiotensin-aldosterone blockade.ResultsA total of 146 patients were studied with a median age 68.7 (60.5–75.4) years and a median eGFR at time of AVF creation of 12.8 (11.3–13.9) mL/min/1.73m2. The crude annual eGFR decline rates were − 3.60 ± 4.00 mL/min/1.73 m2 pre- and − 2.28 ± 3.56 mL/min/1.73 m2 post-AVF, resulting in a mean difference of 1.28 mL/min/1.73 m2 (95% CI 0.49, 2.07). In a mixed effect linear regression model, monthly eGFR decline was − 0.63 (95% CI -0.81, − 0.46; p < 0.001) mL/min/1.73m2/month. The period after AVF creation was associated with a relatively higher eGFR (β 0.94, 95% CI 0.61–1.26, p < 0.001). There was a significant association between follow-up time and the period pre/post AVF (β 0.19, 95% CI 0.16, 0.22; p < 0.001) such that eGFR decline was more attenuated each month after AVF creation.ConclusionsIn this cohort, AVF creation was associated with a significant reduction of eGFR decline. Further prospective studies are needed to confirm this association.
Highlights
Arteriovenous fistula (AVF) is the vascular access of choice for patients on hemodialysis
The identification of a potentially new target to slow Chronic kidney disease (CKD) progression is of the greatest interest, especially knowing that AVF is considered the best vascular access for chronic hemodialysis due to its superior durability and lower risk of adverse events compared to central venous catheter (CVC) or arteriovenous graft (AVG) [13]
Median estimated glomerular filtration rate (eGFR) at hemodialysis initiation (n = 78) was 8.2 (IQR 6.9–9.9) mL/min/1.73 m2and the median time between AVF creation and dialysis start among these patients was 332 (246–472) days. (Table 2) Overall, there was no significant difference in mean systolic blood pressure (BP) before and after AVF creation (145.9 ± 18.9 vs. 146.6 ± 17.2 mmHg, p = 0.49)
Summary
Arteriovenous fistula (AVF) is the vascular access of choice for patients on hemodialysis. The study objective was to assess the impact of the AVF creation on eGFR decline, after controlling for key confounding factors. Authors raised the hypothesis that arteriovenous fistula (AVF) creation might slow CKD progression [10, 11] and delay hemodialysis. The identification of a potentially new target to slow CKD progression is of the greatest interest, especially knowing that AVF is considered the best vascular access for chronic hemodialysis due to its superior durability and lower risk of adverse events compared to central venous catheter (CVC) or arteriovenous graft (AVG) [13]. This study aimed to assess the association between AVF creation and eGFR decline in CKD patients. It was postulated that eGFR decline would be slower after AVF creation even when taking into account potential confounders
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