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A Novel Murine Model of Arteriovenous Fistula Failure: The Surgical Procedure in Detail
Published on: February 3, 2016
Risks of arteriovenous fistula failure in hemodialysis patients older than 75 years
Shunta Hori1, Mitsuru Tomizawa2, Kuniaki Inoue2
1Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. horimaus@gmail.com.
Background:
Arteriovenous fistula (AVF) failure remains a major clinical problem in older patients undergoing hemodialysis. However, the relative contributions of risk factors and their time-dependent effects remain unclear.
Methods:
We retrospectively analyzed 303 patients aged ≥ 75 years in whom AVFs were created. Cox proportional hazards models were used to identify the independent predictors of AVF failure within 1 year. Relative importance was assessed using the likelihood ratio chi-square statistic, and time-dependent effects were evaluated using Schoenfeld residuals.
Results:
AVF failure within 1 year occurred in 30 patients (9.9%), including 10 patients who experienced early failure. Malnutrition, prolonged surgical time, and arterial calcification were identified as independent predictors. Each factor contributed comparably, accounting for approximately one-third of the model contribution. The effect of surgical time was attenuated after approximately 6 months.
Conclusions:
AVF failure in older patients is multifactorial, with comparable contributions from vascular, nutritional, and procedural factors.
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