Natural History of Common Autologous Arteriovenous Fistulae: Consequences for Planning of Dialysis Access

Abstract

The aim was to study primary failure, maturation times, and survival of common arteriovenous fistulae (AVF) to aid planning for vascular access, and to assess which strategy results in most dialysis days. This was a longitudinal cohort study. Two databases of access operations and dialysis sessions over 9 years with 12-year follow-up were reviewed. Functional dialysis use is defined as achieving six consecutive dialysis sessions with two needles on AVF. Primary failure (PF) is failure to achieve functional dialysis use. Maturation time, calculated only for patients on dialysis with a central line at AVF operation, is defined from the operation date to the functional dialysis date. Cumulative patency, including PF, is calculated from the operation to date of AVF abandonment and is compared using Kaplan–Meier curves and adjusted hazard ratios (HRs). A total of 1206 AVF, 689 (57%) radiocephalic AVF (RCAVF), 383 (32%) brachiocephalic AVF (BCAVF), and 134 (11%) brachiobasilic AVF (BBAVF), were analysed. PF was 23%. PF was lower for BCAVF (17%) than RCAVF (26%) and BBAVF (26%) (p = .006). PF was higher for women (OR 1.59, 95% CI: 1.21–2.09) and patients with vascular kidney disease (OR 1.69, 95% CI: 1.19–2.59). Median maturation time was 10.3 weeks. Cumulative patency was worse for BCAVF (HR 1.36, 95% CI: 1.03–1.81) and BBAVF (HR 1.63 95% CI: 1.12–2.38), for patients on dialysis at AVF creation (HR 1.55, 95% CI: 1.13–2.12), and diabetics (HR 1.55, 95% CI: 1.12–1.85). RCAVFs resulted in 3% more dialysis-person-years (py) per 100 operations for all patients and in 15% more dialysis-py in the over 80s. RCAVFs have higher PF, but better survival than other AVF, and result in more dialysis time. AVF created pre-dialysis have better survival. An average maturation time of 10 weeks should be considered if planning to start dialysis on an AVF.