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The association between multimorbidity and arteriovenous fistula creation outcomes
Jose L Lopez1, Theodore H Yuo2, Mehrnaz Siavoshi3
1Department of Surgery, Division of Vascular Surgery, University of California Los Angeles, Los Angeles, CA.
Objective:
The multimorbidity weighted index (MWI) quantifies both cumulative disease burden and its impact on physical functioning. This study examined the association between MWI and short-term outcomes of arteriovenous fistula (AVF) creation for hemodialysis access.
Methods:
We performed a retrospective review of AVFs created between January 2011 and December 2019 of national Vascular Quality Initiative data linked to United States Renal Data Systems data. The primary exposure was multimorbidity as measured by the MWI. The MWI was dichotomized as above or below the median. The primary outcome was functional AVF use within 6 months. Multivariable logistic regression was performed with age, sex, race, cannulation site, and MWI as covariates.
Results:
A total of 9023 patients were included. The mean age was 65 years and the cohort was predominantly male and identified as White. The median follow-up was 14 months (interquartile range, 3-33 months). The median MWI was 8.3. Of the 9023 AVF created, 5578 (61.8%) were used within 6 months of creation, and the median time to first use was 4 months (interquartile range, 3-5 months). Upper arm AVFs were more likely to be used within 6 months than forearm (62.7% vs 59.4%; P = .004). Of the 5578 patients who used their access within 6 months, 2199 (39.4%) required at least one revision before first AVF use, with most undergoing one (73.8%) or two (21.3%) revisions. Patients with an MWI greater than the median (>MED) compared with patients with MWI less than or equal to the median (
Conclusions:
Patients undergoing AVF creation have a high MWI. In this cohort, a higher MWI was associated with increased mortality, a lower likelihood of AVF use within 6 months, and greater odds of revision before first AVF use. The MWI may be a valuable adjunct to guide vascular access planning and shared decision-making.
Insights
High multimorbidity, measured by the Multimorbidity Weighted Index (MWI), is linked to worse outcomes after arteriovenous fistula (AVF) creation for hemodialysis access. Higher MWI correlates with reduced AVF use and increased revisions.
Area of Science:
- Nephrology
- Vascular Surgery
- Health Services Research
Background:
- The Multimorbidity Weighted Index (MWI) assesses cumulative disease burden and functional impact.
- Arteriovenous fistula (AVF) creation is crucial for hemodialysis (HD) access.
- Understanding factors influencing AVF outcomes is vital for patient care.
Purpose of the Study:
- To examine the association between the MWI and short-term outcomes of AVF creation.
- To determine if higher multimorbidity impacts AVF functionality and need for revision.
Main Methods:
- Retrospective review of AVF creation data (2011-2019) from national databases.
- Multimorbidity assessed using the MWI, dichotomized at the median.
- Primary outcome: functional AVF use within 6 months; secondary outcome: AVF revision.
- Multivariable logistic regression analysis performed.
Main Results:
- Higher MWI was associated with lower AVF use within 6 months (58.9% vs. 64.6%).
- Patients with higher MWI were more likely to require AVF revision before first use (43.2% vs. 36.2%).
- Higher MWI correlated with increased mortality and decreased odds of 6-month AVF use.
Conclusions:
- Elevated MWI in patients undergoing AVF creation indicates poorer outcomes.
- Higher MWI is linked to increased mortality, reduced AVF use, and more revisions.
- MWI can aid in vascular access planning and shared decision-making.
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