Factors associated with unsuccessful utilization and early failure of the arterio-venous fistula for hemodialysis.
BACKGROUND
Arteriovenous fistulae survive longer than grafts and catheters. However, their short term outcomes may not be as good. We sought to determine whether fistulae created in patients referred to a nephrologist less than 3 months before dialysis start show higher risk of unsuccessful use and early failure.


METHODS
All patients receiving a new vascular access over a six-year period at three centres were enrolled. Logistic and Cox's regression techniques were used to model late referral on successful utilization for <6 consecutive HD-sessions and time to failure within the first month from access creation, adjusting for demographics, comorbidities and surgical strategies.


RESULTS
Among the 535 subjects enrolled, 513 received a fistula. Without considering revisions, 119 fistulae (23.2%) were not successfully used and 61 (11.9%) failed early. Independent predictors of unsuccessful utilization were late referral (Odds Ratio 2.15 [95% Confidence Interval 1.23, 3.75]), vascular diseases (1.86 [1.16, 2.97]), absence of treated hypertension (2.07 [1.17, 3.68]), and heart failure limited to late referrals (10.74 [4, 28.82]). Late referral (Hazard Ratio 1.72 [1.05, 2.81]), absence of treated hypertension (1.80 [1.02, 3.18]) and heart failure (2.34 [1.34, 4.08]) also predicted primary early failure.


CONCLUSIONS
Late patient referral and presence of cardiovascular diseases, particularly heart failure, are potentially modifiable risk factors for short-term outcomes improvement of hemodialysis fistulae.
Ravani
Pietro
P
Division of Nephrology and Dialysis, Cremona, Italy. p.ravani@libero.it
Barrett
Brendan
B
Mandolfo
Salvatore
S
Brunori
Giuliano
G
Cancarini
Giovanni
G
Imbasciati
Enrico
E
Malberti
Fabio
F
D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D001916:Brachial Artery / Q000601:surgery; D016121:Brachiocephalic Veins / Q000601:surgery; D002318:Cardiovascular Diseases / Q000150:complications; D002408:Catheters, Indwelling; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000601:surgery; D012017:Referral and Consultation; D006435:Renal Dialysis; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D014654:Vascular Patency