title: Arteriovenous fistula creation may slow estimated glomerular filtration rate trajectory.
abstract: BACKGROUND
  We practice the timely placement of an arteriovenous fistula (AVF) in patients facing chronic hemodialysis. We have anecdotally observed after AVF creation that there appears to be a slowing of the decline in kidney function as measured by the estimated glomerular filtration rate (eGFR). There are physiologically plausible explanations as to how an AVF might alter kidney function, but this clinical observation has been attributed to improved compliance and/or other practices. The present retrospective observational analysis was performed to assess the possibility that a successfully created AVF could be associated with the slowing of the eGFR trajectory.
  
  
  METHODS
  We identified 123 patients between 2005 and 2010 with at least two eGFR determinations for 2 years before and up to 2 years after AVF creation. Inclusion eligibility was that the fistula was maturing by the nephrologists' initial post-creation examination. Termination events were death, starting dialysis or transplantation. Each subject served as their own control for the pre- and post-AVF-creation eGFR measurements.
  
  
  RESULTS
  Subjects' median age was 68 years and 56% were diabetic. The rate of change of the eGFR for the 2 years prior to AVF creation was -5.9 mL/min/year (95% CI: -5.3, -6.5) and after AVF creation -0.5 mL/min/year (95% CI: -1.1, 0.1) (interaction (P < 0.001).
  
  
  CONCLUSIONS
  A functioning AVF may be associated with a slowing of the eGFR decline. Agreeing to timely AVF creation selects patients in an otherwise typical population and other confounders have not yet been eliminated. To do so a thorough prospective observational study is indicated.
authors.affiliation: Medicine/Nephrology/Vanderbilt Center for Kidney Diseases, Vanderbilt University Medical Center and Dialysis Clinics Incorporated, Nashville, TN, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Golper
authors.affiliation: Medicine/Nephrology/Vanderbilt Center for Kidney Diseases, Vanderbilt University Medical Center and Dialysis Clinics Incorporated, Nashville, TN, USA.
authors.forename: Phillip Matthew
authors.initials: PM
authors.lastname: Hartle
authors.affiliation: Medicine/Nephrology/Vanderbilt Center for Kidney Diseases, Vanderbilt University Medical Center and Dialysis Clinics Incorporated, Nashville, TN, USA.
authors.forename: Aihua
authors.initials: A
authors.lastname: Bian
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: HD access; arteriovenous fistula; chronic kidney disease; eGFR trajectory; hemodialysis