title: Increasing the proportion of autologous arteriovenous fistulas does not diminish fistula patency.
abstract: OBJECTIVE
  Arteriovenous fistulas (AVF) constructed before and after initiating the kidney disease outcomes and quality initiative (KDOQI) guidelines were reviewed at a single academic center to identify decreased patency with use of potentially inferior vein conduits.
  
  
  METHODS
  Primary access procedures performed pre- and post-adoption of KDOQI guidelines were compared for the primary outcomes of maturation rate and primary patency and the secondary outcome of access utilization.
  
  
  RESULTS
  The proportion of autologous AVFs created was higher post-KDOQI (73% vs 35%, P < .001), and an increased use of the basilic vein was observed (20% vs 2%, P < .05). The failure rate of fistula maturation was reduced post-KDOQI (24% vs 38%, P < .05); however, access utilization was also decreased (59% vs 75%, P < .001).
  
  
  CONCLUSIONS
  Adherence to KDOQI guidelines for AVFs does not compromise fistula patency and increased use of the basilic vein may lead to superior fistula maturation rates. Early referral may result in lower fistula utilization rates, however.
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC, USA. ruddy@musc.edu
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Ruddy
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Brothers
authors.forename: Jacob G
authors.initials: JG
authors.lastname: Robison
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Elliott
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D016009:Chi-Square Distribution; D019983:Guideline Adherence; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D006435:Renal Dialysis; D012189:Retrospective Studies; D013022:South Carolina; D013997:Time Factors; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014654:Vascular Patency; D014680:Veins / Q000637:transplantation