Early Predictors of Arteriovenous Fistula Maturation: A Novel Perspective on an Enduring Problem
| Autor: | Jill Barker-Finkel, Timmy Lee, Crystal A. Farrington, Michelle L. Robbin, Michael Allon |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
congenital
hereditary and neonatal diseases and abnormalities medicine.medical_specialty Ejection fraction Vascular disease business.industry medicine.medical_treatment 030232 urology & nephrology Arteriovenous fistula Hemodynamics General Medicine Odds ratio 030204 cardiovascular system & hematology medicine.disease Confidence interval 03 medical and health sciences 0302 clinical medicine Clinical Research Nephrology Internal medicine medicine Cardiology cardiovascular diseases Hemodialysis business Dialysis |
| Zdroj: | J Am Soc Nephrol |
| ISSN: | 1533-3450 1046-6673 |
| Popis: | Background Preoperative ultrasound mapping is routinely used to select vessels meeting minimal threshold diameters for surgical arteriovenous fistula (AVF) creation but fails to improve AVF maturation rates. This suggests a need to reassess the preoperative ultrasound criteria used to optimize AVF maturation. Methods We retrospectively identified 300 catheter-dependent patients on hemodialysis with a new AVF created between 2010 and 2016. We then evaluated the associations of preoperative vascular measurements and hemodynamic factors with unassisted AVF maturation (successful use for dialysis without prior intervention) and overall maturation (successful use with or without prior intervention). Multivariable logistic regression was used to identify preoperative factors associated with unassisted and overall AVF maturation. Results Unassisted AVF maturation associated with preoperative arterial diameter (adjusted odds ratio [aOR], 1.50 per 1-mm increase; 95% confidence interval [95% CI], 1.23 to 1.83), preoperative systolic BP (aOR, 1.16 per 10-mm Hg increase; 95% CI, 1.05 to 1.28), and left ventricular ejection fraction (aOR, 1.07 per 5% increase; 95% CI, 1.01 to 1.13). Overall AVF maturation associated with preoperative arterial diameter (aOR, 1.36 per 1-mm increase; 95% CI, 1.10 to 1.66) and preoperative systolic BP (aOR, 1.17; 95% CI, 1.06 to 1.30). Using receiver operating curves, the combination of preoperative arterial diameter, systolic BP, and left ventricular ejection fraction was fairly predictive of unassisted maturation (area under the curve, 0.69). Patient age, sex, race, diabetes, vascular disease, obesity, and AVF location were not associated with maturation. Conclusions Preoperative arterial diameter may be an under-recognized predictor of AVF maturation. Further study evaluating the effect of preoperative arterial diameter and other hemodynamic factors on AVF maturation is needed. |
| Databáze: | OpenAIRE |
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