Clinical outcomes after arteriovenous fistula creation in chronic kidney disease.
BACKGROUND
Optimal timing of arteriovenous fistula (AVF) surgery in chronic kidney disease (CKD) is uncertain.


METHODS
A single-centre retrospective study of pre-dialysis CKD patients having first AVF surgery.


RESULTS
The median estimated glomerular filtration rate (eGFR) at the time of AVF surgery in 100 patients was 15 ml/min/1.73 m(2), with patients classified as having an early AVF if eGFR was >15 ml/min/1.73 m(2) (n = 46) or a late AVF if eGFR was ≤15 ml/min/1.73 m(2) (n = 54). In the eGFR ≤15 group, 81% of patients started haemodialysis (HD), compared with 63% of the eGFR >15 patients (p = 0.04). The median time to starting HD was 30.3 months in the eGFR >15 group compared to 10.7 months for the eGFR ≤15 group (log rank p = 0.018). There were no differences in the requirements for a dialysis catheter (eGFR >15 24% vs. eGFR ≤15 11%, p = 0.20) or additional access procedures between the two groups.


CONCLUSIONS
AVF surgery with an eGFR >15 ml/min/1.73 m(2) was associated with a higher risk of AVF non-use and a more prolonged time to the need for HD.
Department of Nephrology, Austin Health, Heidelberg, Vic., Australia.
Mardiana
M
Lee
Matthew A
MA
Roberts
Maree-Ross
MR
Smith
Jason
J
Chuen
Peter F
PF
Mount
D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors