A prospective study of factors associated with successful maturation of arteriovenous fistulas for hemodialysis

Nadia Elizabeth Saavedra Fuentes; Juan Reyna Blanco; Gloria Queipo Garcia; Monserrat Perez Navarro; Claudia Lerma Gonzalez; Rafael Valdez-Ortiz

doi:10.15557/jou.2024.0030

Abstract

Aim

Our objective was to determine the factors associated with the successful maturation of arteriovenous fistulas during hemodialysis.

Material and methods

This prospective study included patients treated with hemodialysis and predialysis patients. Clinical, biochemical, sociodemographic, vascular ultrasound mapping, flow-mediated dilatation, and surgical factors were analyzed. Success in the maturation process was defined by ultrasonographic criteria at six weeks.

Results

Thirty-seven patients were included. With a mean ± standard deviation age of 40 ± 14 years, 73% were male, 65% had type-2 diabetes mellitus, and 95% had hypertension. Arteriovenous fistulas were brachycephalic in 18 patients (49%), brachymedian in nine patients (24%), brachycommunicating posterior in five patients (14%), brachibasal in three patients (8%), radiocephalic in two patients (8%), and radiocephalic in two patients (5%). Fourteen percent of patients had unsuccessful maturation. The vein diameter was 4.3 ± 1.0 mm (maturation group) vs 3.2 ± 0.9 mm (non-maturation group), p = 0.04. The artery diameter was similar: 4.5 ± 0.6 vs 4.5 ± 0.4, p = 0.88. Logistic regression analysis revealed that the diameter of the vein for which the surgery was performed was the factor associated with successful maturation in our population, odds ratio = 4.77 (1.14–19.97), p-value = 0.032.

Conclusions

It is highly important to plan vascular access in patients to perform vascular mapping and measure veins and arteries in patients. Vein measurement is a significant factor in successful maturation of the arteriovenous fistulas.

References

Santoro D, Benedetto F, Mondello P, Pipitò N, Barillà D, Spinelli F et al.: Vascular access for hemodialysis: current perspectives. Int J Nephrol Renovasc Dis 2014; 7: 281–294. doi: 10.2147/IJNRD.S46643.
Open DOI Search in Google Scholar Back to article
Nguyen M, Thankam FG, Agrawal DK: Sterile inflammation in the pathogenesis of maturation failure of arteriovenous fistula. J Mol Med (Berl) 2021; 99: 729–741. doi: 10.1007/s00109-021-02056-4.
Open DOI Search in Google Scholar Back to article
Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A et al.; Dialysis Access Consortium Study Group: Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA 2008; 299: 2164–2171. doi: 10.1001/jama.299.18.2164
Open DOI Search in Google Scholar Back to article
Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX et al.: Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and metaanalysis. Am J Kidney Dis 2014; 63: 464–478. doi: 10.1053/j.ajkd.2013.08.023.
Open DOI Search in Google Scholar Back to article
Allon M, Greene T, Dember LM, Vita JA, Cheung AK, Hamburg NM et al.; Hemodialysis Fistula Maturation Study Group: Association between Preoperative Vascular Function and Postoperative Arteriovenous Fistula Development. J Am Soc Nephrol 2016; 27: 3788–3795. doi: 10.1681/ASN.2015020141.
Open DOI Search in Google Scholar Back to article
Sichona AS, Kyaruzi VM, Joseph A, Mavura MP, Khamisi RH: Factors Associated with Arteriovenous Fistula Maturation Failure among Patients Undergoing Hemodialysis in Hospitals Based in a Low and Middle-Income Country. MedRxiv. 2023; 2023: 1–16. doi 14.23288585.
Search in Google Scholar Back to article
Quinn RR, Oliver MJ, Devoe D, Poinen K, Kabani R, Kamar F et al.: The Effect of Predialysis Fistula Attempt on Risk of All-Cause and Access-Related Death. J Am Soc Nephrol 2017; 28: 613–620. doi: 10.1681/ASN.2016020151.
Open DOI Search in Google Scholar Back to article
Vachharajani TJ: Pre-Access Creation Evaluation – Is Vein Mapping Enough? Adv Chronic Kidney Dis 2015; 22: 420–424. doi: 10.1053/j.ackd.2015.08.002.
Open DOI Search in Google Scholar Back to article
Georgiadis GS, Charalampidis DG, Argyriou C, Georgakarakos EI, Lazarides MK: The Necessity for Routine Pre-operative Ultrasound Mapping Before Arteriovenous Fistula Creation: A Meta-analysis. Eur J Vasc Endovasc Surg 2015; 49: 600–605. doi: 10.1016/j.ejvs.2015.01.012.
Open DOI Search in Google Scholar Back to article
Sidawy AN, Gray R, Besarab A, Henry M, Ascher E, Silva M Jr et al.: Recommended standards for reports dealing with arteriovenous hemodialysis accesses. J Vasc Surg 2002; 35: 603–610. doi: 10.1067/mva.2002.122025.
Open DOI Search in Google Scholar Back to article
Lazarides MK, Georgiadis GS, Tzilalis VD: Diabetes should not preclude efforts for creation of a primary radiocephalic fistula. Nephrol Dial Transplant 2002; 17: 1852–1853. doi: 10.1093/ndt/17.10.1852-a.
Open DOI Search in Google Scholar Back to article
Silva MB Jr, Hobson RW 2nd, Pappas PJ, Jamil Z, Araki CT, Goldberg MC et al.: A strategy for increasing use of autogenous hemodialysis access procedures: impact of preoperative noninvasive evaluation. J Vasc Surg 1998; 27: 302–307. doi: 10.1016/s0741-5214(98)70360-x.
Open DOI Search in Google Scholar Back to article
McGrogan DG, Maxwell AP, Khawaja AZ, Inston NG: Current tools for prediction of arteriovenous fistula outcomes. Clin Kidney J 2015; 8: 282–289. doi: 10.1093/ckj/sfv019.
Open DOI Search in Google Scholar Back to article
Naidu OA, Rajasekhar D, Latheef SA: Assessment of endothelial function by brachial artery flow mediated dilatation in microvascular disease. Cardiovasc Ultrasound 2011; 9: 40. doi: 10.1186/1476-7120-9-40.
Open DOI Search in Google Scholar Back to article
Nantakool S, Prasannarong M, Srisuwan T, Reanpang T, Apichartpiyakul P, Rerkasem K: Agreement between physical and ultrasound examination for arteriovenous fistula maturation diagnostics in Thai hemodialysis patients. J Vasc Access 2022; 23: 123–127. doi: 10.1177/1129729820983177.
Open DOI Search in Google Scholar Back to article
Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K et al.; National Kidney Foundation: KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020; 75 (4 Suppl 2): S1–S164. doi: 10.1053/j. ajkd.2019.12.001. Erratum in: Am J Kidney Dis 2021; 77: 551. doi: 10.1053/j. ajkd.2021.02.002.
Open DOI Search in Google Scholar Back to article
Weisbord SD, Fried LF, Arnold RM, Fine MJ, Levenson DJ, Peterson RA, Switzer GE: Prevalence, severity, and importance of physical and emotional symptoms in chronic hemodialysis patients. J Am Soc Nephrol 2005; 16: 2487–2494. doi: 10.1681/ASN.2005020157.
Open DOI Search in Google Scholar Back to article
Konner K: Primary vascular access in diabetic patients: an audit. Nephrol Dial Transplant 2000; 15: 1317–1325. doi: 10.1093/ndt/15.9.1317.
Open DOI Search in Google Scholar Back to article
Davidson I, Gallieni M. Optimizing vascular access in the elderly: words we use affect patient care. J Vasc Access 2015; 16: 437–438. doi: 10.5301/jva.5000466.
Open DOI Search in Google Scholar Back to article
Kurella M, Covinsky KE, Collins AJ, Chertow GM: Octogenarians and nonagenarians starting dialysis in the United States. Ann Intern Med 2007; 146: 177–183. doi: 10.7326/0003-4819-146-3-200702060-00006.
Open DOI Search in Google Scholar Back to article
Foote C, Ninomiya T, Gallagher M, Perkovic V, Cass A, McDonald SP, Jardine M: Survival of elderly dialysis patients is predicted by both patient and practice characteristics. Nephrol Dial Transplant 2012; 27: 3581–3587. doi: 10.1093/ndt/gfs096.
Open DOI Search in Google Scholar Back to article
Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN: A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg 2007; 45: 420–426. doi: 10.1016/j.jvs.2006.10.035.
Open DOI Search in Google Scholar Back to article
Jennings WC, Landis L, Taubman KE, Parker DE: Creating functional autogenous vascular access in older patients. J Vasc Surg 2011; 53: 713–719. doi: 10.1016/j. jvs.2010.09.057.
Open DOI Search in Google Scholar Back to article
Peterson WJ, Barker J, Allon M: Disparities in fistula maturation persist despite preoperative vascular mapping. Clin J Am Soc Nephrol 2008; 3: 437–441. doi: 10.2215/CJN.03480807.
Open DOI Search in Google Scholar Back to article
Saran R, Robinson B, Abbott KC, Agodoa LY, Albertus P, Ayanian J et al.: US Renal Data System 2016 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis 2017; 69 (3 Suppl 1): A7–A8. doi: 10.1053/j. ajkd.2016.12.004. Erratum in: Am J Kidney Dis 2017; 69: 712. doi: 10.1053/j. ajkd.2017.03.001.
Open DOI Search in Google Scholar Back to article
Woo K, Gascue L, Goldman DP, Romley JA: Variations in outcomes of hemodialysis vascular access by race/ethnicity in the elderly. J Vasc Surg 2017; 65: 783–792. e4. doi: 10.1016/j.jvs.2016.09.054.
Open DOI Search in Google Scholar Back to article
Kalantar-Zadeh K, Abbott KC, Salahudeen AK, Kilpatrick RD, Horwich TB: Survival advantages of obesity in dialysis patients. Am J Clin Nutr 2005; 81: 543–554. doi: 10.1093/ajcn/81.3.543.
Open DOI Search in Google Scholar Back to article
Stolic R: Obesity in renal failure – health or disease? Med Hypotheses 2010; 75: 497–500. doi: 10.1016/j.mehy.2010.07.004.
Open DOI Search in Google Scholar Back to article
Chan MR, Young HN, Becker YT, Yevzlin AS: Obesity as a predictor of vascular access outcomes: analysis of the USRDS DMMS Wave II study. Semin Dial 2008; 21: 274–279. doi: 10.1111/j.1525-139X.2008.00434.x.
Open DOI Search in Google Scholar Back to article
Kats M, Hawxby AM, Barker J, Allon M: Impact of obesity on arteriovenous fistula outcomes in dialysis patients. Kidney Int 2007; 71: 39–43. doi: 10.1038/sj.ki.5001904.
Open DOI Search in Google Scholar Back to article
Singh P, Robbin ML, Lockhart ME, Allon M: Clinically immature arteriovenous hemodialysis fistulas: effect of US on salvage. Radiology 2008; 246: 299–305. doi: 10.1148/radiol.2463061942.
Open DOI Search in Google Scholar Back to article
Krochmal DJ, Rebecca AM, Kalkbrenner KA, Casey WJ, Fowl RJ, Stone WM et al.: Superficialization of deep arteriovenous access procedures in obese patients using suction-assisted lipectomy: A novel approach. Can J Plast Surg 2010; 18: 25–27. doi: 10.1177/229255031001800112.
Open DOI Search in Google Scholar Back to article
Chitalia N, Ross L, Krishnamoorthy M, Kapustin A, Shanahan CM, Kaski JC et al.: Neointimal hyperplasia and calcification in medium sized arteries in adult patients with chronic kidney disease. Semin Dial 2015; 28: E35–40. doi: 10.1111/sdi.12335.
Open DOI Search in Google Scholar Back to article
Joannides R, Haefeli WE, Linder L, Richard V, Bakkali EH, Thuillez C, Lüscher TF: Nitric oxide is responsible for flow-dependent dilatation of human peripheral conduit arteries in vivo. Circulation 1995; 91 :1314–1319. doi: 10.1161/01.cir.91.5.1314.
Open DOI Search in Google Scholar Back to article
Green DJ, Dawson EA, Groenewoud HM, Jones H, Thijssen DH: Is flow-mediated dilation nitric oxide mediated? A meta-analysis. Hypertension 2014; 63: 376–382. doi: 10.1161/HYPERTENSIONAHA.113.02044.
Open DOI Search in Google Scholar Back to article
Bellien J, Iacob M, Gutierrez L, Isabelle M, Lahary A, Thuillez C, Joannides R: Crucial role of NO and endothelium-derived hyperpolarizing factor in human sustained conduit artery flow-mediated dilatation. Hypertension 2006; 48: 1088–1094. doi: 10.1161/01.HYP.0000246672.72188.bd.
Open DOI Search in Google Scholar Back to article
Wall LP, Gasparis A, Callahan S, van Bemmelen P, Criado E, Ricotta J: Impaired hyperemic response is predictive of early access failure. Ann Vasc Surg 2004; 18: 167–171. doi: 10.1007/s10016-004-0006-9.
Open DOI Search in Google Scholar Back to article
Wong CS, McNicholas N, Healy D, Clarke-Moloney M, Coffey JC, Grace PA, Walsh SR: A systematic review of preoperative duplex ultrasonography and arteriovenous fistula formation. J Vasc Surg 2013; 57: 1129–1133. doi: 10.1016/j. jvs.2012.11.094.
Open DOI Search in Google Scholar Back to article
Georgiadis GS, Charalampidis DG, Argyriou C, Georgakarakos EI, Lazarides MK: The Necessity for Routine Pre-operative Ultrasound Mapping Before Arteriovenous Fistula Creation: A Meta-analysis. Eur J Vasc Endovasc Surg 2015; 49: 600–605. doi: 10.1016/j.ejvs.2015.01.012.
Open DOI Search in Google Scholar Back to article
Wells AC, Fernando B, Butler A, Huguet E, Bradley JA, Pettigrew GJ: Selective use of ultrasonographic vascular mapping in the assessment of patients before haemodialysis access surgery. Br J Surg 2005; 92: 1439–1443. doi: 10.1002/bjs.5151.
Open DOI Search in Google Scholar Back to article
Smith GE, Samuel N, Khan J, Johnson BF, Chetter IC: Targeted duplex ultrasound in a one-stop dialysis vascular access assessment clinic. Ann Vasc Surg 2011; 25: 1099–1103. doi: 10.1016/j.avsg.2011.02.043.
Open DOI Search in Google Scholar Back to article
Lampropoulos G, Papadoulas S, Katsimperis G, Ieronimaki AI, Karakantza M, Kakkos SK, Tsolakis I: Preoperative evaluation for vascular access creation. Vascular 2009; 17: 74–82. doi: 10.2310/6670.2009.00007.
Open DOI Search in Google Scholar Back to article
Sidawy AN, Spergel LM, Besarab A, Allon M, Jennings WC, Padberg FT Jr et al.; Society for Vascular Surgery. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg 2008; 48 (5 Suppl): 2S–25S. doi: 10.1016/j.jvs.2008.08.042.
Open DOI Search in Google Scholar Back to article
Parmar J, Aslam M, Standfield N: Pre-operative radial arterial diameter predicts early failure of arteriovenous fistula (AVF) for haemodialysis. Eur J Vasc Endovasc Surg 2007; 33: 113–115. doi: 10.1016/j.ejvs.2006.09.001.
Open DOI Search in Google Scholar Back to article
Korten E, Toonder IM, Schrama YC, Hop WC, van der Ham AC, Wittens CH: Dialysis fistulae patency and preoperative diameter ultrasound measurements. Eur J Vasc Endovasc Surg 2007; 33: 467–471. doi: 10.1016/j.ejvs.2006.10.035.
Open DOI Search in Google Scholar Back to article
Nicolosi AC, Pohl LL, Parsons P, Cambria RA, Olinger GN: Increased incidence of radial artery calcification in patients with diabetes mellitus. J Surg Res 2002; 102: 1–5. doi: 10.1006/jsre.2001.6303.
Open DOI Search in Google Scholar Back to article
Lee T, Chauhan V, Krishnamoorthy M, Wang Y, Arend L, Mistry MJ et al.: Severe venous neointimal hyperplasia prior to dialysis access surgery. Nephrol Dial Transplant 2011; 26: 2264–2270. doi: 10.1093/ndt/gfq733.
Open DOI Search in Google Scholar Back to article
Jemcov TK: Morphologic and functional vessels characteristics assessed by ultrasonography for prediction of radiocephalic fistula maturation. J Vasc Access 2013; 14: 356–363. doi: 10.5301/jva.5000163.
Open DOI Search in Google Scholar Back to article

A prospective study of factors associated with successful maturation of arteriovenous fistulas for hemodialysis

Abstract

Aim

Material and methods

Results

Conclusions

Paradigm

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