title: Factors associated with unsuccessful utilization and early failure of the arterio-venous fistula for hemodialysis.
abstract: 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.
authors.affiliation: Division of Nephrology and Dialysis, Cremona, Italy. p.ravani@libero.it
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.forename: Brendan
authors.initials: B
authors.lastname: Barrett
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mandolfo
authors.forename: Giuliano
authors.initials: G
authors.lastname: Brunori
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cancarini
authors.forename: Enrico
authors.initials: E
authors.lastname: Imbasciati
authors.forename: Fabio
authors.initials: F
authors.lastname: Malberti
mesh_terms: 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