Related Experiment Video
Updated: Aug 29, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Cardiovascular comorbidity and late referral impact arteriovenous fistula survival: a prospective multicenter study
Pietro Ravani1, Giuliano Brunori, Salvatore Mandolfo
1Section of Nephrology, Division of Nephrology and Dialysis, Cremona Hospital, Italy. p.ravani@libero.it
Insights
Autologous arteriovenous fistulas (AVF) show reduced survival with cardiovascular disease, late referral, and early cannulation. Allowing AVF at least one month to mature improves outcomes for hemodialysis patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Clinical Epidemiology
Background:
- Autologous arteriovenous fistulas (AVF) are the preferred vascular access for hemodialysis due to superior patency and lower complication rates.
- Optimal maturation periods and risk factors influencing AVF survival remain incompletely understood.
Purpose of the Study:
- To identify risk factors associated with AVF failure, maturation time, and long-term survival.
- To determine optimal maturation requirements for maximizing AVF longevity.
Main Methods:
- A longitudinal cohort study included 535 patients initiating hemodialysis between 1997 and 2002 across three centers.
- Cox regression analysis was employed to assess predictors of primary and secondary AVF survival.
Main Results:
- Cardiovascular disease, utilization before one month post-placement, and late referral (<3 months) were linked to reduced primary AVF survival.
- Presence of cardiovascular disease, maturation time less than 15 days, and initial use of temporary catheters were associated with lower secondary AVF survival.
- Patients initiating hemodialysis with catheters had significantly shorter AVF maturation times.
Conclusions:
- Cardiovascular disease, delayed referral for AVF creation, reliance on temporary catheters, and premature cannulation negatively impact AVF survival.
- AVF should be allowed a minimum maturation period of one month before cannulation to optimize functional longevity.
Abstract:
Autologous arteriovenous fistulas (AVF) have the best 5-yr patency and the lowest complication rate among hemodialysis vascular accesses. However, maturation requirements to optimize survival are unknown. A longitudinal cohort study was conducted to ascertain risk factors for failure, maturation time, and survival of the first AVF. All patients who initiated hemodialysis between January 1, 1997, and December 31, 2002, in three centers were included in this study. Analysis was restricted to patients who received an AVF. Cox regression was used to estimate the association between predictors of interest and primary and secondary AVF survival. Of the 535 patients enrolled (mean age, 66.5 yr; 57.8% male; 26.7% diabetic), 513 (96%) received an AVF. Patients who initiated with catheters (47%) cannulated their AVF earlier (median maturation period, 0.78 versus 1.80 mo; P < 0.001). Median primary and secondary survivals were longer than 50 and 72 mo, respectively. After adjustment for confounding factors, cardiovascular disease (hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.26 to 2.67), utilization earlier than 1 mo after placement (HR, 1.94; 95% CI, 1.34 to 2.82), and referral within 3 mo of dialysis start (HR, 1.55; 95% CI, 1.04 to 2.32) were associated with a reduction in primary AVF survival. Presence of cardiovascular disease (HR, 2.21; 95% CI, 1.38 to 3.55), maturation time <15 d (HR, 2.12; 95% CI, 1.20 to 3.73), and presence of catheters at hemodialysis initiation (HR, 1.79; 95% CI, 1.13 to 2.84) were associated with lower secondary AVF survival. It is concluded that cardiovascular disease, late referral, temporary catheters, and early cannulation are associated with impaired AVF survival. It is recommended that AVF be allowed to mature at least 1 mo before cannulation.
