title: Comorbidities do not influence primary fistula success in incident hemodialysis patients: a prospective study.
abstract: OBJECTIVE
  Concern about primary fistula failure may contribute to the underuse of arteriovenous fistula. The objective of this study was to investigate the baseline clinical parameters associated with primary fistula success.
  
  
  METHODS
  Consecutive incident patients who commenced dialysis during a 28-mo period in a regional renal program were studied. Data on patient-related variables and on surgical approach (e.g., whether the surgeons routinely assess vessel size during the operation) were collected. Primary fistula success was defined as an arteriovenous fistula that was able to afford successful dialysis for 3 h with blood pump speed of > or =300 ml/min for three consecutive sessions.
  
  
  RESULTS
  A total of 205 (69%) patients had an AVF attempted as their first vascular access. The overall primary success rate was 64% and was similar for radiocephalic and brachiocephalic fistula. Logistic regression was done separately for patients with the two types of fistula because of the presence of statistical interaction. For radiocephalic fistula, male gender was the only parameter associated with primary fistula success (odds ratio 3.57; P = 0.01). The presence of comorbidity was not significantly associated with primary fistula failure.
  
  
  CONCLUSIONS
  Despite significant patient comorbidity, there was a high primary fistula success rate among this incident hemodialysis cohort. Given that vessel size may be the ultimate determinant of fistula success, if surgeons assess vessel size perioperatively, then the presence of significant comorbidity might not preclude arteriovenous fistula from being attempted as the initial access.
authors.affiliation: Division of Nephrology, University of Calgary, Foothills Medical Center, Calgary, Canada.
authors.forename: Wenjie
authors.initials: W
authors.lastname: Wang
authors.forename: Brendan
authors.initials: B
authors.lastname: Murphy
authors.forename: Serdar
authors.initials: S
authors.lastname: Yilmaz
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
authors.forename: Jennifer
authors.initials: J
authors.lastname: Macrae
authors.forename: Braden J
authors.initials: BJ
authors.lastname: Manns
mesh_terms: D000368:Aged; D000416:Alberta / Q000453:epidemiology; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D015897:Comorbidity; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D016896:Treatment Outcome