TY - JOUR
T1 - Predictors of Arteriovenous Fistula Failure
T2 - A Post Hoc Analysis of the FAVOURED Study
AU - Pey See, Yong
AU - Cho, Yeoungjee
AU - Pascoe, Elaine M.
AU - Cass, Alan
AU - Irish, Ashley
AU - Voss, David
AU - Polkinghorne, Kevan R.
AU - Hooi, Lai Seong
AU - Ong, Loke Meng
AU - Paul-Brent, Peta Anne
AU - Kerr, Peter G.
AU - Mori, Trevor A.
AU - Hawley, Carmel M.
AU - Johnson, David W.
AU - Viecelli, Andrea K.
N1 - Publisher Copyright:
Copyright © 2020 by the American Society of Nephrology.
PY - 2020/11/1
Y1 - 2020/11/1
N2 - Background An autologous arteriovenous fistula (AVF) is the preferred hemodialysis vascular access, but successful creation is hampered by high rates of AVF failure. This study aimed to evaluate patient and surgical factors associated with AVF failure to improve vascular access selection and outcomes. Methods This is a post hoc analysis of all participants of FAVOURED, a multicenter, double-blind, multinational, randomized, placebo-controlled trial evaluating the effect of fish oil and/or aspirin in preventing AVF failure in patients receiving hemodialysis. The primary outcome of AVF failure was a composite of fistula thrombosis and/or abandonment and/or cannulation failure at 12 months post-AVF creation, and secondary outcomes included individual outcome components. Patient data (demographics, comorbidities, medications, and laboratory data) and surgical factors (surgical expertise, anesthetic, intraoperative heparin use) were examined using multivariable logistic regression analyses to evaluate associations with AVF failure. Results Of 536 participants, 253 patients (47%) experienced AVF failure during the study period. The mean age was 55±14.4 years, 64% were male, 45% were diabetic, and 4% had peripheral vascular disease. Factors associated with AVF failure included female sex (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.20 to 2.68), lower diastolic BP (OR for higher DBP, 0.85; 95% CI, 0.74 to 0.99), presence of central venous catheter (OR, 1.49; 95% CI, 1.02 to 2.20; P0.04), and aspirin requirement (OR, 1.60; 95% CI, 1.00 to 2.56). Conclusions Female sex, requirement for aspirin therapy, requiring hemodialysis via a central venous catheter, and lower diastolic BP were factors associated with higher odds of AVF failure. These associations have potential implications for vascular access planning and warrant further studies.
AB - Background An autologous arteriovenous fistula (AVF) is the preferred hemodialysis vascular access, but successful creation is hampered by high rates of AVF failure. This study aimed to evaluate patient and surgical factors associated with AVF failure to improve vascular access selection and outcomes. Methods This is a post hoc analysis of all participants of FAVOURED, a multicenter, double-blind, multinational, randomized, placebo-controlled trial evaluating the effect of fish oil and/or aspirin in preventing AVF failure in patients receiving hemodialysis. The primary outcome of AVF failure was a composite of fistula thrombosis and/or abandonment and/or cannulation failure at 12 months post-AVF creation, and secondary outcomes included individual outcome components. Patient data (demographics, comorbidities, medications, and laboratory data) and surgical factors (surgical expertise, anesthetic, intraoperative heparin use) were examined using multivariable logistic regression analyses to evaluate associations with AVF failure. Results Of 536 participants, 253 patients (47%) experienced AVF failure during the study period. The mean age was 55±14.4 years, 64% were male, 45% were diabetic, and 4% had peripheral vascular disease. Factors associated with AVF failure included female sex (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.20 to 2.68), lower diastolic BP (OR for higher DBP, 0.85; 95% CI, 0.74 to 0.99), presence of central venous catheter (OR, 1.49; 95% CI, 1.02 to 2.20; P0.04), and aspirin requirement (OR, 1.60; 95% CI, 1.00 to 2.56). Conclusions Female sex, requirement for aspirin therapy, requiring hemodialysis via a central venous catheter, and lower diastolic BP were factors associated with higher odds of AVF failure. These associations have potential implications for vascular access planning and warrant further studies.
KW - arteriovenous access
KW - arteriovenous fistula
KW - dialysis
KW - hemodialysis
KW - hemodialysis access
KW - vascular access
UR - http://www.scopus.com/inward/record.url?scp=85113456341&partnerID=8YFLogxK
U2 - 10.34067/KID.0002732020
DO - 10.34067/KID.0002732020
M3 - Article
C2 - 35372875
AN - SCOPUS:85113456341
SN - 2641-7650
VL - 1
SP - 1259
EP - 1269
JO - Kidney360
JF - Kidney360
IS - 11
ER -