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Independent prediction factors for primary patency loss in arteriovenous grafts within six months
Mauricio Monroy-Cuadros1, Serdar Yilmaz, Anastasio Salazar-Bañuelos
1Division of Transplantation, Department of Surgery, Faculty of Medicine, University of Calgary, Calgary AB, Foothills Medical Center, Calgary, AB, Canada. mauricio.monroy@albertahealthservices.ca
Insights
Arteriovenous grafts (AVGs) often fail early in hemodialysis patients. Low blood flow, diabetes, older age, and peripheral vascular disease are key risk factors for AVG failure, necessitating closer monitoring.
Area of Science:
- Nephrology
- Vascular Surgery
- Clinical Epidemiology
Background:
- Arteriovenous grafts (AVGs) are crucial vascular access for chronic hemodialysis.
- Early loss of functional patency in AVGs leads to increased reliance on catheters.
- Identifying risk factors for AVG failure is essential for optimizing patient care.
Purpose of the Study:
- To investigate associations between demographic and clinical factors and early loss of primary functional patency in AVGs.
- To identify patient characteristics that predict failure of AVGs within six months of use.
- To inform strategies for improving AVG longevity and reducing catheter dependence.
Main Methods:
- Retrospective analysis of chronic hemodialysis patients with AVGs.
- Comparison of demographic and clinical variables between patients with and without loss of primary functional patency.
- Multivariable logistic regression to identify independent predictors of primary patency loss.
Main Results:
- Primary failure occurred in 30% of AVGs.
- Low initial intra-access blood flow (<650 mL/min) was strongly associated with patency loss (OR 31).
- Diabetes (OR 3.5), older age (>65 years, OR 3.2), and peripheral vascular disease (OR 2.5) were also independent risk factors for AVG failure.
Conclusions:
- Specific patient characteristics predict early failure of arteriovenous grafts.
- Close monitoring of AVGs in patients with identified risk factors may improve access longevity.
- Understanding these factors can help select appropriate vascular access for hemodialysis patients.
Purpose:
The objective of this study was to explore the association between loss of primary functional patency within 6 months of first use and demographic and clinical characteristics in patients with arteriovenous grafts (AVGs) receiving chronic hemodialysis. The knowledge and management of these characteristics will minimize the proportion of catheterdependent dialysis patients for whom AVGs are the best choice.
Methods:
This was a retrospective study of all chronic hemodialysis patients with AVGs followed by the Southern Alberta Renal Program from January 2005 to June 2008. Demographic and clinical variables and initial intra-access blood flow (IABF) were compared between those with and without loss of primary functional patency. To determine the contribution of independent variables to the dependant variable of loss of primary functional patency, a multivariable analysis using logistic regression was performed.
Results:
The incidence of primary failure was 30% (107/359). Multivariable analysis found that low initial IABF (<650 mL/ min, odds ratio [OR] 31, P < 0.001), presence of diabetes (OR 3.5, P = 0.001), older age (>65 years OR 3.2, P< 0.001), and presence of peripheral vascular disease (OR 2.5, P< 0.005) were independently associated with loss of primary patency.
Conclusions:
AVGs are sometimes a better choice for those patients in which the time to and probability of successful fistula maturation may be a concern. Close monitoring of AVGs in patients with the identified risk factors associated with loss of primary patency may improve the life expectancy of the access.
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