Primary arteriovenous fistula functionality and complications in patients with advanced chronic kidney disease: A...

Native arteriovenous fistula (AVF) is the preferred vascular access for long-term hemodialysis. Primary non-function and inadequate maturation remain clinically significant problems, and detailed single-centre outcome series contribute to the evidence base, particularly in patient populations with a high prevalence of comorbidities such as diabetes mellitus.

To describe the recorded functionality categories and postoperative complication profile after primary AVF creation in patients with advanced chronic kidney disease (CKD), and to identify baseline characteristics independently associated with an adverse functionality category.

This single-centre outcomes study prospectively collected data on 96 consecutive adults with stage 4-5 CKD who underwent primary native AVF creation during 2020-2021. The primary endpoint was a three-level ordered functionality category: non-functional (0), functional at 12 months (1), and functional at 36 months (2).

Mean age was 65.8 ± 11.6 years; 60 patients (62.5%) were male. Forty-five patients (46.9%) had diabetes mellitus; 50 (52.1%) received a distal and 46 (47.9%) a proximal AVF. Twenty-two AVFs (22.9%) were non-functional, 27 (28.1%) were functional at 12 months, and 47 (49.0%) were functional at 36 months. In the adjusted binary logistic model, diabetes mellitus was strongly associated with primary non-function (adjusted OR 27.79, 95% CI 5.56-138.84; p < 0.001), while proximal AVF location offered a prognostic advantage (adjusted OR 0.22, 95% CI 0.07-0.74; p = 0.014). In the adjusted ordinal model, diabetes was associated with lower odds of a more favorable functionality category (adjusted OR 0.24, 95% CI 0.14-0.41; p < 0.001), and proximal AVF location with higher odds (adjusted OR 2.71, 95% CI 1.62-4.55; p < 0.001).

Diabetes mellitus was the strongest baseline predictor of primary AVF non-function and adverse recorded functionality in this outcomes series. Proximal AVF location was independently associated with a more favorable functionality category.