[Risk factors for the development of different variants of primary arteriovenous fistula dysfunction in patients on...

The incidence of primary dysfunction of arteriovenous fistulas (AVF) created as a permanent vascular access (PVA) for maintenance hemodialysis (HD) remains high, reaching 20-30%. Various risk factors lead to AVF delayed maturation and thrombosis.

We aimed to identify risk factors for the development of such variants of primary AVF failure as delayed maturation and thrombosis.

Our retrospective cohort study included a total of 1595 adult patients first starting maintenance HD treatment. Primary AVF dysfunction was defined as failure of successful double-needle puncture for standard HD or hemodiafiltration, insufficient blood flow into the extracorporeal circuit three months after the permanent vascular access had been created, or the development of AVF thrombosis before its first successful use.

The mean age of the patients was 49.1±8.6 years, ranging from 22 to 81 years. There were 720 (45.1%) females and 875 (54.9%) males. The average body mass index amounted to 28.4±3.7, ranging from 17.5 to 40.7 kg/m2. Primary AVF failure was found to occur in 369 patients (23.1% of 1595). Of these, 127 (34.4% of 369, 8.0% of 1595) had AVF delayed maturation and 242 (65.6% of 369, 15.2% of 1595) had thrombosis. The risk factors for thrombosis were as follows: persistent hypotension, polycystic kidney disease, and systemic processes (vasculitis, multiple myeloma, HIV-associated nephropathy, etc.): RR=2.2 [95% CI 1.6; 3.1], p<0.001; RR=3.2 [95% CI 2.5; 4.2], p<0.001; RR=5.3 [95% CI 4.4; 6.5], p<0.001, respectively. The risk factors for delayed maturation included female sex, persistent hypotension, diabetes mellitus, polycystic kidney disease, and excess body weight: RR=2.7 [95% CI 1.9; 3.9], p<0.001; RR=2.8 [95% CI 1.8; 4.4], p<0.001; RR=3.3 [95% CI 2.4; 4.6], p<0.001; RR=7.1 [95% CI 5.3; 9.6], p<0.001; RR=2.3 [95% CI 1.3; 3.8], p=0.002, respectively. A preoperative ultrasound examination performed by or in the presence of the operating surgeon was an important factor contributing to a decrease in the incidence of both variants of dysfunction. Formation of a permanent vascular access within 4 weeks before HD and within two weeks thereafter was associated with an increased risk of thrombosis.

AVF thrombosis and delayed maturation, as types of primary failure are influenced by different risk factors. The surgeon-performed preliminary examination should be supplemented with Doppler ultrasonography of the zone of AVF creation to select an optimal vascular access.