Abstract
IntroductionWith increasing numbers of patients diagnosed with ESRD, arteriovenous fistula (AVF) maturation has become a major factor in improving both dialysis related outcomes and quality of life of those patients. Compared to other types of access it has been established that a functional AVF access is the least likely to be associated with thrombosis, infection, hospital admissions, secondary interventions to maintain patency and death.AimStudy of demographic factors implicated in the functional maturation of arteriovenous fistulas. Also, to explore any possible association between preoperative haematological investigations and functional maturation.MethodsWe performed a retrospective chart review of all patients with ESRD who were referred to the vascular service in the University Hospital of Limerick for creation of vascular access for HD. We included patients with primary AVFs; and excluded those who underwent secondary procedures.ResultsOverall AVF functional maturation rate in our study was 53.7% (52/97). Female gender showed significant association with nonmaturation (P = 0.004) and was the only predictor for non-maturation in a logistic regression model (P = 0.011). Patients who had history of renal transplant (P = 0.036), had relatively lower haemoglobin levels (P = 0.01) and were on calcium channel blockers (P = 0.001) showed better functional maturation rates.ConclusionFemale gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation. In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.
Highlights
With increasing numbers of patients diagnosed with end stage renal disease (ESRD), arteriovenous fistula (AVF) maturation has become a major factor in improving both dialysis related outcomes and quality of life of those patients
Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation
A mature and functional arteriovenous fistula (AVF) is considered the best modality for HD access when compared to arteriovenous grafts (AVG) and central venous catheters (CVC) [3,4,5], it is expected that approximately one third (20%–50%) of AVFs will fail to mature into useful access [6,7,8]
Summary
The objective of this paper was to report our own findings from the last 7 years in a regional hospital situated in the Mid-Western area of the Ireland in relation to patients’ characteristics and comorbidities that might affect the process of AVF maturation according to predefined outcomes. We aimed to test the hypothesis that certain patients’ characteristics affect the maturation of AVF. We aimed to evaluate patients’ characteristics that have been reported to be associated with AVF non-maturation in the literature following an extensive review of published evidence
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