Early Arteriovenous Fistula Failure Research Articles

Hemodialysis is the most prevalent modality of renal replacement therapy. The durability of hemodialysis and its quality depend on consistent and reliable access to the patient's vascular system. In this systematic review we provide a comprehensive analysis of the predictors of primary arteriovenous fistula failure. A systematic search was conducted in PubMed, Web of Science, ScienceDirect, and the WHO Virtual Health Library Regional Portal from database inception through March 2025. Search terms included combinations of 'arteriovenous fistula', 'failure', 'hemodialysis', 'end-stage renal disease', and 'risk factors'. Four reviewers independently screened titles and abstracts, with full texts assessed according to predefined inclusion criteria. Studies were eligible if they examined risk factors for primary arteriovenous fistula failure in adult patients on hemodialysis. A total of 38 studies were included in the systematic review. Early arteriovenous fistula failure was significantly associated with a distal location of the fistula, small arterial diameter, small vein diameter, low serum albumin level, female gender, diabetes mellitus, and decreased systolic and diastolic blood pressure. This systematic review identified several key risk factors for early arteriovenous fistula failure in patients with end-stage renal disease (ESRD) undergoing hemodialysis. These factors should be considered from a patient safety perspective and included in the shared decision-making process with patients who are candidates for arteriovenous fistula surgery. Optimizing these factors may enhance fistula maturation and reduce the need for repeat vascular access procedures. However, recognizing that some risk factors may not be readily modifiable in ESRD patients, clinicians should balance optimization efforts with the urgency of establishing vascular access.

Risk factors for early arteriovenous fistula failure in patients undergoing hemodialysis and comparison of diagnostic prediction models.

Arteriovenous fistula (AVF) is preferred for hemodialysis. However, early thrombosis often leads to failure. Hence, this observational study of 200 patients compared AVF outcomes with and without intraoperative heparin use. Thrombosis within 30 days was significantly lower in the heparin group (11% vs. 25%, p = 0.01). Smaller vein diameter was an independent risk factor, while heparin improved maturation and short-term patency. Despite minor bleeding, heparin prophylaxis was safe and may reduce early AVF failure.

To the best of our knowledge, a possible predictive relationship between the systemic coagulation-inflammation index (SCI) and arteriovenous fistula (AVF) failure following AVF creation has not yet been examined. We therefore designed this study to examine the predictive ability of SCI on postoperative early AVF failure in patients undergoing primary radiocephalic AVF operation. A total of 189 patients who underwent primary radiocephalic AVF operation for hemodialysis access were included in this retrospective observational cohort study, and then divided into two groups according to whether AVF failure occurred within the first 3 months after the operation; as failed AVF group (n = 44) and non-failed AVF group (n = 145). The patients' baseline clinical characteristics and laboratory parameters were recorded and then compared between the groups. Patients in failed AVF group were significantly older and had higher smoking rate than those in non-failed AF group. The median values of fibrinogen, platelet-to-lymphocyte ratio and SCI were significantly higher in failed AVF group than in non-failed AVF group. With regards to other clinical characteristics and laboratory parameters, no significant differences were detected between the groups in the univariate analyses. Only age and SCI maintained their significances in the multivariate logistic regression analysis, and were therefore considered as the independent predictors of AVF failure. ROC curve analysis revealed that SCI of 37.9 constituted the optimum cut-off value with 97.7% sensitivity and 94.5% specificity rates for predicting AVF failure. The present study demonstrated for the first time in the literature that SCI significantly and independently predicted early AVF failure following radiocephalic AVF creation.

Background Arteriovenous-fistula (AVF) are crucial for hemodialysis access, yet they frequently experience early failure. While studies have identified potential patient and clinical risk factors, these findings remain inconsistent. This inconsistency might be attributed to the varying definitions of “early failure”. Our retrospective cohort study aimed to evaluate how common risk factors predict four frequently early-failure criteria: thrombosis/stenosis, <500 ml/min blood flow, <5 mm vein diameter, and ≥6 mm deep vein. We also assessed how well these risk factors predict early failure defined as meeting at least one of these criteria. Additionally, we examined the predictive ability of vein-distensibility, a previously overlooked factor in AVF failure. Methods Consecutive patients with first-time AVF employing standard minimum preoperative artery- and vein-diameters (1.8–2.0 mm) who underwent first Doppler-ultrasound (DUS) at ≤4 months in 2016–2022 were identified. Early AVF failure was defined as the presence of at least one of the following conditions on the first DUS: poor blood flow (Qa), poor vein diameter, poor vein depth, and thrombosis/stenosis. Factors associated with early AVF failure were explored with multivariate analyses. Results 105 patients were eligible and 63 (60%) had an early AVF failure. The only strong predictor of early failure was low vein-distensibility (Odds ratio = 0.57, 95% confidence intervals [CIs] = 0.38–0.83, p = 0.005). Female sex only predicted too-deep veins (Odds ratio = 14.29, 95% CIs = 2.00–100, p = 0.024). Conclusions venous distensibility may be a useful early-failure determinant when minimum preoperative vessel-diameter limits are met. Moreover, the female sex is associated with too-deep AVF veins.

Hemodialysis is a prevalent treatment for the end-stage chronic kidney disease (CKD) worldwide. The primary arteriovenous fistula (AVF), widely considered the optimal hemodialysis access method, fails to mature in up to two-thirds of the cases. The etiology of the early AVF failure, defined as thrombosis or inability to use within three months post-creation remains less understood, and is influenced by various factors including patient demographics, surgical techniques, and genetic predispositions. Neointimal hyperplasia is a primary histological finding in stenotic lesions leading to the AVF failure. However, there are insufficient data on the cellular phenotypes and the impact of the preexisting CKD-related factors. This study aims to investigate the histological, morphometric, and immunohistochemical alterations in the fistula vein, pre-, peri-, and post-early failure. Eighty-nine stage 4-5 CKD patients underwent standard preoperative assessment, including the Doppler ultrasound, before a typical radio-cephalic AVF creation. Post-failure, a new AVF was created proximally. The vein specimens were collected during the surgery, processed, and analyzed for morphometric analyses and various cellular markers, including Vimentin, TGF, and Ki 67. The study enrolled 89 CKD patients, analyzing various aspects of their condition and AVF failures. The histomorphometric analysis revealed substantial venous luminal stenosis and varied endothelial changes. The immunohistologic analysis showed differential marker expressions pre- and post-AVF creation. This study highlights the complexity of the early AVF failures in CKD patients. The medial hypertrophy emerged as a significant preexisting lesion, while the postoperative analyses indicated a shift towards neointimal hyperplasia. The research underscores the nuanced interplay of vascular remodeling, endothelial damage, and cellular proliferation in the AVF outcomes.

Omentin reduces venous neointimal hyperplasia in arteriovenous fistula through hypoxia-inducible factor-1 alpha inhibition

This study investigates the impact of blood pressure variability (BPV) on early failure and patency outcomes of arteriovenous fistulas (AVFs) in patients with end-stage renal disease (ESRD). Short-term and long-term BPV parameters, including standard deviation of systolic blood pressure (SBP-SD), blood pressure variability coefficient (BCV), and average real variability (ARV), were analyzed in 100 patients who underwent AVF surgery between 2019 and 2023. The results indicate that high BPV significantly increases the risk of early AVF failure (hazard ratio [HR] = 1.48, 95% confidence interval [CI]: 1.23-1.75, P < 0.01). Kaplan-Meier analysis revealed a significantly higher rate of patency failure in patients with persistently high BPV (Log-rank P < 0.01). The influence of BPV on AVF function is independent of traditional risk factors, suggesting that clinical monitoring and control of BPV can help improve AVF prognosis. Future research is needed to validate its predictive value through larger sample sizes and longer follow-up periods.

Arteriovenous fistula (AVF) patency is important for patients undergoing hemodialysis. The association between early AVF failure and the prognosis, including all-cause mortality and major adverse cardiovascular events (MACE), has not been fully investigated. The present study was performed to investigate the association between early AVF failure and 3-year mortality, cardiovascular disease (CVD) mortality, and MACE. We analyzed 358 patients who started hemodialysis in our institution from October 2008 to February 2020. We defined early AVF failure as cases requiring percutaneous transluminal angioplasty or reoperation within 1 year after AVF surgery. The patients were divided into two groups according to the presence or absence of early AVF failure, and the prognosis of each group was examined. The association between early AVF failure and outcomes (3-year all-cause mortality, CVD mortality, and MACE) was determined using Cox proportional hazards regression analysis. During the 3-year follow-up, 75 (20.9%) patients died (cardiovascular death: n = 39) and 145 patients developed MACE. According to the multivariable analysis, the early AVF failure group had a significantly higher risk of 3-year all-cause mortality (hazard ratio [HR], 1.42; 95% confidence interval [CI], 1.09-1.83; p = 0.009), CVD mortality (HR, 1.54; 95% CI, 1.29-2.08; p < 0.001), and MACE (HR, 1.68; 95% CI, 1.25-2.26; p < 0.001). When the patients were stratified by age, early AVF failure was associated with 3-year all-cause mortality in all groups except for the younger group (<65 years of age). Early AVF failure was associated with an increased risk of 3-year all-cause mortality, CVD mortality, and MACE.

Introduction: AVF is the best option for hemodialysis access, but its patency rate drops after one year. UC-MSCs were used to reduce inflammation and promote vascular tissue repair in AVF rabbit models. Methods: In this study, 28 male domestic rabbits (Lepus Domestica) were divided into four groups: KN as a negative control, KP as a positive control with placebo therapy, P1 as the treatment group with in situ UC-MSCs, and P2 as the treatment group with intravenous UC-MSCs. The UC-MSCs dose administered was 1,000,000 cells per kilogram of body weight. After 28 days, all groups of rabbit models with AVF were sacrificed. HIF-1α, eNOS, and MMP-2 levels were measured using ELISA Sandwich methods and analyzed using a one-way ANOVA test followed by post hoc Duncan test. Results: The study found significant differences in HIF-1α, eNOS, and MMP-2 levels among the treatment groups. P3 and P4 treatments did not significantly differ in HIF-1α levels, but P3 had a lower average HIF-1α level than P4. The KP group had the highest concentration of eNOS, significantly higher than P1, P2, and KN. ENOs concentration decreased in P1 and P2 and was significantly lower than KP. The level of MMP-2 in AVF rabbits that received intravenous UC-MSCs was significantly higher than that of healthy rabbits (KN), but significantly lower than the AVF rabbit group that received a placebo. The MMP-2 level in AVF rabbits receiving in situ UC-MSCs was significantly lower than in the placebo and intravenous UC-MSC groups. Conclusion. This study suggests that local delivery of in situ UC-MSCs targeting HIF-1α, eNOS, and MMP-2 levels can effectively reduce intimal hyperplasia (IH) in rabbit models of AVF, potentially preventing early AVF failure and serving as a promising therapy to prevent and reduce IH in AVF.

End-stage renal disease is a crippling diagnosis that generally requires dialysis to prolong life. To facilitate filtration of patient's blood in dialysis, surgical formation of an arteriovenous fistula (AVF) is commonly performed. Maturation of the AVF is required to allow for successful dialysis. However, AVFs commonly fail to mature, leading to the fistula closure, the necessity for another fistula site, and markedly increased morbidity and mortality. The current literature concerning molecular mechanisms associated with AVF maturation failure supports the role of inflammatory mediators involving immune cells and inflammatory cytokines. However, the role of oncostatin M (OSM), an inflammatory cytokine, and its downstream targets are not well investigated. Through inflammation, oxidative stress, and hypoxic conditions, the vascular tissue surrounding the AVF undergoes fibrosis, stenosis, and wall thickening, leading to complete occlusion and nonfunctional. In this report, first we critically review the existing literature on the role of OSM in the most common causes of early AVF failure - vascular inflammation, thrombosis, and stenosis. We next consider the potential of using OSM as a therapeutic target, and finally discuss therapeutic agents targeting inflammatory mediators involved in OSM signaling to potentiate successful maturation of the AVF.

Background: Identification and control of clinical predictors of arteriovenous (AVF) failure can improve the long-term outcome of hemodialysis patients. The effects of these factors on the outcome of AVF are not still clear. So, we aimed this study to compare the effect of hypertension and diabetes on early failure of AVF.Methods: In this retrospective study, we evaluated 400 patients with ESRD referred to our clinic for the creation of the first AVF from July 14, 2001, through August 7, 2018. One month after AVF creation, the patients were referred to the clinic for patency control. Demographic characteristics, previous history of diabetes and hypertension, and laboratory data of all patients were recorded preoperatively. Data were entered to SPSS v.24 and Study data were analyzed with chi-square and independent student t-test. Then, early failure of AVF and its relationship with a history of diabetes and hypertension were assessed. Results: There was no statistically significant relationship between the history of diabetes and early AVF failure risk in ESRD patients (OR, 0.78; 95% CI, 0.25 to 2.43). Furthermore, the history of hypertension was significantly lower in the early failure of AVF group (OR, -2.82; 95% CI, -1.42 to -5.59). Although, this effect faded when using regression analysis (OR, -2.67; 95% CI, -0.97 to -7.36). There was a higher Body mass index in the non-early failure group (p = 0.041). There was no significant difference in age (p = 0.512), gender (p = 0.091), history of smoking (p = 0.605), treatment with insulin (p = 0.683), oral antidiabetic agents (p = 0.734), duration of diabetes (p = 0.384), and duration of hypertension (p = 0.093). Conclusion: We reported that the history of diabetes was not higher in the early failure group, while there was a lower risk of AVF failure in patients with a previous history of hypertension.

Introduction: Hemodialysis is one of the renal replacement therapies used for end-stage renal disease (ESRD) patients. Arteriovenous fistula (AVF) is the preferred hemodialysis access type because it has better patency rates and fewer complications than other access types. However, around 31-61% of AVF fail to mature. An early AVF failure may be due to a lack of maturation or thrombosis, and late failure defines as a failure after successful use. Some factors that make AVF fail are injury of the endothelial wall or hypercoagulation. This study aimed to determine the association between pre-operative platelet and hematocrit value with AVF failure in BHCC Clinic Denpasar. Method: This is an analytic cross-sectional study. The data were collected from medical records from all dialytic patients from January 2020-December 2020. Patients with inclusion criteria were collected. Patient with incomplete data was excluded. Data were analyzed using Chi-square analysis. Results: Our study involved 34 patients, 21(61.8%) of them were male, and the mean age was 52.62 years (±10.77 SD). The AVF failure prevalence was 32.4% (n=11). We found no association between platelet value with AVF failure, with a p-value=0.411. There was an association between hematocrit value and AVF failure in hemodialysis patients with a p-value=0.032. Most of the patient was male and aged 45-60 with ESRD from the characteristic found. Conclusion: There was an association between pre-operative hematocrit value and AVF failure in hemodialysis patients. There was no association between pre-operative platelet value with AVF failure.

Prognostic Factors for the Survival of Early Arteriovenous Fistula Failure in Patients with End Stage Renal Disease

Arteriovenous fistula (AVF) is the most preferred vascular access for hemodialysis patients, and early failure of AVF is one of the most avoidable complications of this procedure. We retrospectively evaluated whether adjuvant systemic heparinization just before arterial manipulation could reduce early failure of primary AVF. Three hundred and fifty-six patients with end-stage renal failure who underwent primary AVF surgery from April 2009 to September 2020 were enrolled in this study. The patients were divided into two groups based on whether they received adjuvant heparinization or not. Patient backgrounds, frequency of early AVF failure, and bleeding events were compared between the two groups. Multivariate Cox regression analysis identified risk factors for early AVF failure. Early failure of AVF was observed in only 2 of 157 patients (1.2%) in the adjuvant group, and the incident was significantly lower than observed in the non-adjuvant group, i.e., 17 of 199 patients (8.5%) (p = 0.002). Bleeding events were not significantly different between the two groups. Seven of 157 patients (4.5%) in the adjuvant group and 7 of 199 patients (3.5%) in the non-adjuvant group experienced bleeding events (p = 0.785). Female sex, use of steroids, hypoalbuminemia, venous stenosis in pre-surgical evaluation, arterial spasm in the perioperative period, new-onset venous stenosis after AVF anastomosis, technical failure of surgery, no early cannulation after surgery, and non-adjuvant heparinization were related to early AVF failure in the multivariate regression analysis. Adjuvant systemic heparinization therapy just before arterial manipulation reduced early failure of primary AVF without increasing bleeding events.

Abstract Background and Aims The native arteriovenous fistula (AVF) is the vascular access point for hemodialysis (HD) in end-stage renal disease (ESRD) patients undergoing HD. The challenge in the follow up of any AVF is to reach a correct maturation state and a higher longevity. The neutrophils to lymphocytes ratio (NLR) and the platelets to lymphocytes ratio (PLR) have been reported in many papers to be prognostic indicators for the AVF failure which seems to be associated with high levels of NLR or PLR. This study aimed to evaluate the role of preoperative NLR and PLR in predicting early AVF failure. Method We conducted a retrospective study including 31 patients who are hemodialysis (HD) in our center and who benefited from an AVF confection during 2019 and 2020. The threshold ratios found in the literature from which the risk of AVF early failure is significant are NLR&amp;gt; = 2.5 and PLR&amp;gt; = 150. These values have been considered the references in our work. Results The average age of our patients is 50 years (20-84 years). The sex ratio is equal to 1,38 (18 men and 13 women). 20 patients started HD when they were under 60 years old and 11 patients after the age of 60. We noticed smoking, obesity, hypertension and diabetes respectively in 16%, 45%, 77%, and 32% of our patients. The causal nephropathy is respectively undetermined in 10 cases, interstitial in 7 cases, diabetic in 6 cases, glomerular in 5 cases and vascular in 3 cases. The type of AVF is proximal in 19 cases (61%) and distal in 12 cases (38%). The AVF failure occurred in 19%. The causes of AVF early failure are respectively a thrombosis in 3 cases, a stenosis in 2 cases and non maturing AVF in one case. The mean NLR is 4,47 (1,09 -17). The mean PLR is 193 (80-397). 74% of our patients have a NLR ≥2,5 and 26% less than 2,5. 61% of the patients have a PLR ≥150 and 39% less than 150. All the patients with an AVF failure have a NLR ≥2,5 however only 5 persons have a PLR ≥150. Among the 6 patients with an AVF failure, the AVF is proximal in 5 cases and distal in one case. We divided our population in two groups: group1 patients with an AVF failure (6 patients) and group2 who don’t have an AVF failure (25 patients). Afterwards, we have studied the correlations between these 2 groups with the NLR interval and PLR interval. We didn’t find any significant correlation between the occurrence of AVF failure with the NLR interval (p=0,11) and PLR interval (p=0,22). We tried to find values of NLR and PLR for which we found a correlation with the AVF failure using the ROC curve. The best cut off to predict AVF failure is 3,45 for NLR and 204 for PLR. Conclusion We demonstrate throw this study that a high preoperative NLR and PLR can predict the early AVF less. These data may serve as a foundation to develop future research on the role of anti-inflammatory medications in the prevention of AVF failure think that required a larger series and more prolonged follow up.

Arteriovenous fistula (AVF) is the vascular access of choice in prevalent hemodialysis end-stage renal disease (ESRD) patients. However, there was a significant proportion of early AVF failure and its predictive factor was conflicting in several studies. We conducted a retrospective cohort study in 225 AVFs created in 159 patients. The purpose of this study was to identify the predictive factors of AVF early failure. The data variables included age at AVF creation, sex, history of diabetes, hypertension, cigarette smoking, AVF location and side, history of subclavian tunneled dialysis catheter and history of preoperative ultrasound mapping. This information was collected by interviewing the patient and by AVF scar inspection. AVF that was never coming into use was classified as an early failure. AVF creation in the wrist was significantly associated with a higher early failure rate (29.9%) compared with AVF creation at the elbow (4.4%) (p < 0.001). There was no significant association in terms of AVF early failure in terms of the other variables. We concluded that wrist AVF is significantly associated with early failure. However, this finding should not preclude the National Kidney Foundation’s recommendation of using wrist AVF for the first choice of vascular access to conserve more proximal access sites for future use.

ObjectiveThrombophilic risk factors (TRFs) occur rather frequently in hemodialysis (HD) patients. However, little is known about their significance in HD patients, besides their potential impact on arteriovenous (AV) access failure, with varying results. We examined the effects of a wide variety of TRFs on both early AV fistula occlusion and survival among HD patients in long-term follow-up.MethodsIn this single-center, observational study, 70 consecutive HD patients from our dialysis center were examined with respect to shunt occlusion within the first 2 years after fistula creation and patient survival in a long-term follow-up (at least 16 years). We examined the presence of factor V, prothrombin, and MTHFR mutations using real-time fluorescence polymerase chain reaction. Furthermore, antithrombin (AT), protein C, protein S, and antiphospholipid antibodies (APL-Abs) were assessed.ResultsAmong the 70 patients, 32 had MTHFR mutations, 10 had heterozygous factor V Leiden mutations, 4 had prothrombin mutations, 4 had protein S deficiency, 2 had protein C deficiency, 9 had AT deficiency, and 14 had APL-Abs. 40 patients had shunt occlusion. TRFs were associated with a significantly increased risk for shunt thrombosis (P<0.02). Kaplan–Meier analysis with a log-rank test revealed significantly shorter survival in HD patients with TRFs (P<0.02). Cox regression analysis showed that the presence of TRFs (P<0.05; hazard ratio, 1.94; 95% CI: 1.07–3.56), but not early shunt occlusion, was associated with short patient survival.ConclusionsTRFs in hemodialysis patients have a strong impact on patient survival and early AV fistula failure; however, patient survival is not significantly affected by early shunt occlusion.

The first choice of vascular access for hemodialysis in patients with end-stage renal disease is a distal radiocephalic arteriovenous fistula (AVF). Early failure rates for these AVFs vary from 10% to 53%. The effects of predialysis hypotension on failure of AVFs have been described in the literature. Weather lower blood pressures affect early AVF failure has not been extensively studied. We conducted this study to evaluate the effects of preoperative blood pressures on early AVF failure. Ours was a prospective observational study over a period of 2 years that included 224 patients who underwent distal radiocephalic AVF creation. Only those patients were included whose fistulas were made by surgeons with an experience of greater than five cases. The systolic, diastolic, and mean arterial pressures (MAPs) were recorded preoperatively. Early failure was defined as failure to achieve vascular access from the fistula within first 4 months of its creation. The overall early failure rate was 27.7%. Early failure was more common in females and diabetic patients. The systolic, diastolic, and MAPs were significantly lower in patients with early failure (P < 0.05). In a multivariable adjusted analysis, lower preoperative diastolic and MAPs were predictors for early failure of distal radiocephalic AVF. Our study shows that patients with early failure of AVFs have lower preoperative blood pressure. A larger study is required to substantiate our findings and define target preoperative blood pressure for AVF creation.

To evaluate the role of preoperative peripheral blood neutrophil-to-lymphocyte ratio in predicting early arteriovenous fistula failure. The impact of postoperative neutrophil-to-lymphocyte ratio on arteriovenous fistula failure was also investigated. Medical records from 470 patients who underwent first-time arteriovenous fistula creation were studied. Demographic, clinical, and laboratory data were obtained. Receiver operating characteristic curves were constructed to determine the optimal cutoff values of preoperative and postoperative neutrophil-to-lymphocyte ratios for predicting early arteriovenous fistula failure. Univariate and multivariate analyses were performed to evaluate whether the neutrophil-to-lymphocyte ratio parameters were prognostic indicators for arteriovenous fistula failure. Complete data from 396 patients were studied. The prevalence of early arteriovenous fistula failure was 30.6%. The optimal cutoff values of preoperative and postoperative neutrophil-to-lymphocyte ratios for predicting early arteriovenous fistula failure were 2.7 (82.6% sensitivity and 52.0% specificity) and 2.9 (78.5% sensitivity and 73.1% specificity), respectively. By univariate and multivariate analyses, high preoperative and postoperative neutrophil-to-lymphocyte ratios were significantly associated with early arteriovenous fistula failure. The adjusted odds ratios were 5.46 (95% confidence interval: 3.15-9.48) and 7.19 (95% confidence interval: 4.12-12.55), respectively. High preoperative and postoperative neutrophil-to-lymphocyte ratios significantly predict early arteriovenous fistula failure.