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The Long-Term Patency Rate and Factors Influencing Dysfunction of the Autogenous Arteriovenous Fistula in
Qinghua He1, Yu Zhou2, Chen Chen3
1Department of Gynecology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Insights
Autogenous arteriovenous fistula (AV fistula) dysfunction is common. Overweight, low albumin, and high uric acid increase risk, while preemptive creation improves patency, guiding clinical practice for better outcomes.
Area of Science:
- Nephrology
- Vascular Surgery
- Public Health
Background:
- Autogenous arteriovenous fistula (AV fistula) dysfunction presents a significant clinical challenge, impacting patient care and healthcare costs.
- Understanding long-term patency rates and risk factors is crucial for improving hemodialysis access.
Purpose of the Study:
- To investigate the long-term patency rate of AV fistulas.
- To identify factors contributing to AV fistula dysfunction.
- To provide evidence-based guidance for clinical practice.
Main Methods:
- Retrospective cohort study of 226 patients undergoing hemodialysis.
- Analysis of demographic, clinical, and laboratory data from electronic health records.
- Application of Cox proportional hazards regression and Kaplan-Meier survival analysis.
Main Results:
- Cumulative AV fistula patency rates at 12, 36, 60, and 84 months were 82.1%, 60.7%, 45.4%, and 33.5%, respectively.
- Independent predictors of dysfunction included elevated BMI (HR: 1.58), hypoalbuminemia (HR: 2.83), and high uric acid (HR: 1.57).
- Preemptive AV fistula creation was a protective factor (HR: 0.67).
Conclusions:
- Overweight, hypoalbuminemia, and hyperuricemia are independent risk factors for AV fistula dysfunction.
- Preemptive AV fistula creation is associated with improved long-term patency.
- Early intervention and monitoring of these factors are recommended to enhance AV fistula survival.
Introduction:
Autogenous arteriovenous fistula (AV fistula) dysfunction continues to be a widespread clinical challenge, adversely impacting both patients and society as a whole. The aim of this study was to investigate the long-term patency rate of AV fistula, explore the factors that contribute to AV fistula dysfunction, and present the findings in a way that can guide clinical practice.
Methods:
This retrospective cohort study enrolled patients who underwent AV fistula creation and subsequent hemodialysis at a tertiary A-level hospital in Chongqing, China. Demographic, clinical, and laboratory characteristics of the patients, as well as AV fistula dysfunction, were retrospectively reviewed from electronic health records. Cox proportional hazards regression analysis was used to analyze the factors influencing AV fistula dysfunction, and a forest plot was created to visualize the results. Additionally, Kaplan-Meier survival analysis was used to analyze AV fistula survival.
Findings:
This study analyzed 226 patients undergoing hemodialysis, demonstrating cumulative AV fistula patency rates of 82.1% at 12 months, 60.7% at 36 months, 45.4% at 60 months, and 33.5% at 84 months. Univariate Cox proportional hazard regression analysis identified six variables associated with AV fistula dysfunction (p < 0.1): body mass index (BMI), preemptive AV fistula creation, diabetes, total cholesterol, albumin, and uric acid. Subsequent multivariate analysis revealed four independent predictors for dysfunction: elevated BMI (HR: 1.58, p = 0.016), preemptive AV fistula creation (HR: 0.67, p = 0.029), albumin (HR: 2.83, p < 0.001), and uric acid (HR: 1.57, p = 0.020).
Discussion:
Our study findings indicated that overweight, hypoalbuminemia, and high concentrations of uric acid were independent risk factors for AV fistula dysfunction. In contrast, preemptive AV fistula creation was an independent protective factor against AV fistula dysfunction. Therefore, early interventions and surveillance for these factors should be performed to improve long-term AV fistula patency rates.
