title: Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease.
abstract: BACKGROUND
  With increasing numbers of patients diagnosed with ESRD, arteriovenous fistula (AVF) maturation has become a major factor in improving both dialysis related outcomes and quality of life of those patients. Compared to other types of access it has been established that a functional AVF access is the least likely to be associated with thrombosis, infection, hospital admissions, secondary interventions to maintain patency and death.
  
  
  OBJECTIVE
  Study of demographic factors implicated in the functional maturation of arteriovenous fistulas. Also, to explore any possible association between preoperative haematological investigations and functional maturation.
  
  
  METHODS
  We performed a retrospective chart review of all patients with ESRD who were referred to the vascular service in the University Hospital of Limerick for creation of vascular access for HD. We included patients with primary AVFs; and excluded those who underwent secondary procedures.
  
  
  RESULTS
  Overall AVF functional maturation rate in our study was 53.7% (52/97). Female gender showed significant association with nonmaturation (P = 0.004) and was the only predictor for non-maturation in a logistic regression model (P = 0.011). Patients who had history of renal transplant (P = 0.036), had relatively lower haemoglobin levels (P = 0.01) and were on calcium channel blockers (P = 0.001) showed better functional maturation rates.
  
  
  CONCLUSIONS
  Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation. In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: Khalid
authors.initials: K
authors.lastname: Bashar
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: Adeel
authors.initials: A
authors.lastname: Zafar
authors.affiliation: Department of Acute Medicine, James Connolly Memorial Hospital, Dublin, Ireland.
authors.forename: Sawsan
authors.initials: S
authors.lastname: Elsheikh
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: Donagh A
authors.initials: DA
authors.lastname: Healy
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Clarke-Moloney
authors.affiliation: Department of Nephrology, University Hospital Limerick, Limerick, Ireland.
authors.forename: Liam
authors.initials: L
authors.lastname: Casserly
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Burke
authors.affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.
authors.forename: Eamon G
authors.initials: EG
authors.lastname: Kavanagh
authors.affiliation: Department of Surgery, National University of Ireland, Galway, Ireland.
authors.forename: Stewart R
authors.initials: SR
authors.lastname: Walsh
mesh_terms: D000368:Aged; D001158:Arteries; D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D005260:Female; D006403:Hematologic Tests; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D011379:Prognosis; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D014680:Veins
chemical_list: D015415:Biomarkers