Arteriovenous fistula non-use: Insights from Thailand's healthcare experience

While arteriovenous fistulas (AVFs) are preferred for hemodialysis access, the impact of prior central venous catheter (CVC) use on AVF outcomes and health-related quality of life (HRQoL) remain unclear. This study compared composite AVF non-use and complications between patients with prior CVC use and those with preemptive AVF creation over 24 months.

This prospective longitudinal study consecutively enrolled patients with chronic kidney disease (CKD) referral for attended long-term vascular access planning consultations at two tertiary hospitals in northern Thailand (2016-2017). Eligible participants (⩾18 years) undergoing first-time AVF creation were categorized into CVC (first hemodialysis via CVC) and non-CVC (preemptive AVF) groups. Baseline characteristics were compared between groups. Multivariable logistic regression with backward stepwise selection identified predictors of composite AVF non-use in an exploratory analysis. Outcomes included composite AVF non-use (AVF non-use, hemodialysis suitability failure, and early mortality within 12 months), complications, and HRQoL.

Among 167 patients (73 CVC, 94 non-CVC), AVF non-use at 12 months was significantly higher in the non-CVC group (32.9% vs 4.7%, p < 0.001), resulting in lower composite AVF non-use in the CVC group (19.2% vs 47.9%, p < 0.001). Each 1 mL/min/1.73 m² eGFR increase raised composite non-use risk by 7%, while prior CVC use reduced it by 22%. The CVC group had more symptomatic central vein stenosis (11.0% vs 3.2%, p = 0.060) but similar mortality rates. HRQoL improved physically in the CVC group by 18 months, with mental improvements in both groups by 24 months.

Prior CVC use was associated with lower AVF non-use, reflecting better timing of AVF creation based on established dialysis need rather than CVC benefits. High preemptive AVF non-use often resulted from delayed dialysis initiation or changing preferences. These findings support kidney failure risk prediction tools and individualized ESRD life-planning to optimize AVF timing. For patients requiring urgent dialysis initiation, sequential CVC-to-AVF management may represent clinically appropriate care. Optimal results require individualized timing, ongoing reassessment, and strong multidisciplinary coordination.