Predictors of radio-cephalic arteriovenous fistulae patency in an Asian population.

Abstract

To identify predictors of arteriovenous fistula (AVF) patency in Asian patients with autogenous radio-cephalic arteriovenous fistula (RCAVF). Retrospective review of 436 RCAVFs created between 2009 and 2013. Predictors of patency were identified with univariate and multivariate analysis. Kaplan-Meier survival analysis and log-rank test were used to calculate patency rates. Overall secondary patency rate was 72% at 12 months, 69% at 24 months, 58% at 36 months, 57% at 48 months, 56% at 60 months and 54% at 72 months. Univariate analysis showed that factors which predict for patency include male gender (p = 0.003), good diabetic control (p = 0.025), aspirin use (p = 0.031), pre-dialysis status (p = 0.037), radial artery diameter (p = 0.029) and non-calcified radial arteries (p = 0.002). Age (p = 0.866), cephalic vein diameter (p = 0.630) and surgeon grade (p = 0.472) did not predict for primary AVF failure. Multivariate analysis revealed the male gender to be an independent predictor for patency (odds ratio 1.99, p = 0.01). Subset analysis showed a significantly larger average radial artery diameter of 2.3 mm amongst males, as compared to 1.9 mm amongst females (p = 0.001) and no statistical difference in the average cephalic vein diameter. Within our Asian study population, 12-month patency rate of RCAVF is 72%, 69% at 24 months, 58% at 36 months, 57% at 48 months, 56% at 60 months and 54% at 72 months. Male gender is an independent predictor for RCAVF patency. In females or patients with calcified radial arteries, a more proximal AVF should be considered.