Early Predictors of Arteriovenous Fistula Maturation: A Novel Perspective on an Enduring Problem.
arterial diameter
arteriovenous fistula
maturation
ultrasound
vascular mapping
Journal
Journal of the American Society of Nephrology : JASN
ISSN: 1533-3450
Titre abrégé: J Am Soc Nephrol
Pays: United States
ID NLM: 9013836
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
27
08
2019
accepted:
26
03
2020
pubmed:
20
5
2020
medline:
25
2
2021
entrez:
20
5
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32424000
pii: ASN.2019080848
doi: 10.1681/ASN.2019080848
pmc: PMC7351000
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
1617-1627Subventions
Organisme : NIDDK NIH HHS
ID : T32 DK007545
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 by the American Society of Nephrology.
Références
Clin J Am Soc Nephrol. 2019 Jun 7;14(6):954-961
pubmed: 30975657
J Vasc Surg. 2016 Jul;64(1):155-62
pubmed: 27066945
Clin J Am Soc Nephrol. 2016 Oct 7;11(10):1802-1808
pubmed: 27630181
Radiology. 2000 Oct;217(1):83-8
pubmed: 11012427
J Vasc Surg. 1998 Feb;27(2):302-7; discussion 307-8
pubmed: 9510284
Clin J Am Soc Nephrol. 2007 Jul;2(4):786-800
pubmed: 17699495
Am J Kidney Dis. 2018 Apr;71(4):469-478
pubmed: 29198387
Am J Kidney Dis. 2006 May;47(5 Suppl 3):S11-145
pubmed: 16678659
Clin J Am Soc Nephrol. 2016 Sep 7;11(9):1615-23
pubmed: 27577243
Kidney Int. 2003 Jan;63(1):346-52
pubmed: 12472802
J Vasc Surg. 2002 Sep;36(3):460-3
pubmed: 12218967
J Nephrol. 2007 Mar-Apr;20(2):150-63
pubmed: 17514619
Kidney Int. 2006 Oct;70(8):1413-22
pubmed: 16883317
Am J Kidney Dis. 2003 Nov;42(5):1000-12
pubmed: 14582044
Am J Kidney Dis. 2011 Jan;57(1):78-89
pubmed: 21122960
Cochrane Database Syst Rev. 2015 Sep 30;(9):CD007013
pubmed: 26418347
Kidney Int. 2002 Oct;62(4):1109-24
pubmed: 12234281
JAMA. 2008 May 14;299(18):2164-71
pubmed: 18477783
Radiology. 2016 May;279(2):620-9
pubmed: 26694050
Kidney Int. 1998 Feb;53(2):473-9
pubmed: 9461109
Nephrol Dial Transplant. 1998 Jan;13(1):125-9
pubmed: 9481727
J Vasc Surg. 2009 Jun;49(6):1499-504
pubmed: 19497513
Am J Kidney Dis. 2020 Feb;75(2):158-166
pubmed: 31585684
Ann Surg. 2008 May;247(5):885-91
pubmed: 18438128
J Ultrasound Med. 2006 Dec;25(12):1541-5
pubmed: 17121948
Kidney Int. 1999 Jul;56(1):275-80
pubmed: 10411703
J Am Soc Nephrol. 2007 Jun;18(6):1936-41
pubmed: 17475812
Int J Surg. 2015 Mar;15:95-9
pubmed: 25659365
Ann Vasc Surg. 2018 May;49:273-276
pubmed: 29477678
Am J Kidney Dis. 2018 Oct;72(4):509-518
pubmed: 29784614
J Vasc Surg. 2015 Jan;61(1):170-6
pubmed: 25065580
J Vasc Access. 2018 Mar;19(2):167-171
pubmed: 29283177
Kidney Int. 2001 Nov;60(5):2013-20
pubmed: 11703621
J Vasc Interv Radiol. 2013 Sep;24(9):1289-94
pubmed: 23871694
J Am Soc Nephrol. 2015 Dec;26(12):3133-40
pubmed: 25855782
Clin J Am Soc Nephrol. 2008 Mar;3(2):437-41
pubmed: 18235150
Am J Kidney Dis. 2014 Jan;63(1):104-12
pubmed: 23992885
Clin J Am Soc Nephrol. 2018 Sep 7;13(9):1364-1372
pubmed: 30139806
Semin Vasc Surg. 2016 Dec;29(4):153-171
pubmed: 28779782
J Vasc Surg. 2016 Jan;63(1):163-70.e6
pubmed: 26718822
Radiology. 2002 Oct;225(1):59-64
pubmed: 12354984
Clin J Am Soc Nephrol. 2011 Mar;6(3):575-81
pubmed: 21088288
Am J Kidney Dis. 2018 Jun;71(6):793-801
pubmed: 29429750
Nephron Clin Pract. 2005;101(1):c39-44
pubmed: 15886495
J Vasc Interv Radiol. 2006 May;17(5):807-13
pubmed: 16687746
Biomed Res Int. 2018 Jun 11;2018:1520929
pubmed: 29992133
J Ultrasound Med. 2012 Oct;31(10):1581-8
pubmed: 23011621