title: Association between Preoperative Vascular Function and Postoperative Arteriovenous Fistula Development.
abstract: Arteriovenous fistula (AVF) maturation failure is the primary cause of dialysis vascular access dysfunction. To evaluate whether preoperative vascular functional properties predict postoperative AVF measurements, patients enrolled in the Hemodialysis Fistula Maturation Study underwent up to five preoperative vascular function tests (VFTs): flow-mediated dilation (FMD), nitroglycerin-mediated dilation (NMD), carotid-femoral pulse wave velocity, carotid-radial pulse wave velocity, and venous occlusion plethysmography. We used mixed effects multiple regression analyses to relate each preoperative VFT to ultrasound measurements of AVF blood flow rate and venous diameter at 1 day, 2 weeks, and 6 weeks after AVF placement. After controlling for AVF location, preoperative ultrasound measurements, and demographic factors (age, sex, race, and dialysis status), greater NMD associated with greater 6-week AVF blood flow rate and AVF diameter (per absolute 10% difference in NMD: change in blood flow rate =14.0%; 95% confidence interval [95% CI], 3.7% to 25.3%; P<0.01; change in diameter =0.45 mm; 95% CI, 0.25 to 0.65 mm; P<0.001). Greater FMD also associated with greater increases in 6-week AVF blood flow rate and AVF diameter (per absolute 10% difference in FMD: change in blood flow rate =11.6%; 95% CI, 0.6% to 23.9%; P=0.04; change in diameter =0.31 mm; 95% CI, 0.05 to 0.57 mm; P=0.02). None of the remaining VFT parameters exhibited consistent statistically significant relationships with both postoperative AVF blood flow rate and diameter. In conclusion, preoperative NMD and FMD positively associated with changes in 6-week AVF blood flow rate and diameter, suggesting that native functional arterial properties affect AVF development.
authors.affiliation: Division of Nephrology and mdallon@uab.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Allon
authors.affiliation: Division of Nephrology, University of Utah, Salt Lake City, Utah.
authors.forename: Tom
authors.initials: T
authors.lastname: Greene
authors.affiliation: Division of Nephrology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Dember
authors.affiliation: Division of Cardiology, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Vita
authors.affiliation: Division of Nephrology, University of Utah, Salt Lake City, Utah.
authors.forename: Alfred K
authors.initials: AK
authors.lastname: Cheung
authors.affiliation: Division of Cardiology, Boston University School of Medicine, Boston, Massachusetts.
authors.forename: Naomi M
authors.initials: NM
authors.lastname: Hamburg
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; and.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Imrey
authors.affiliation: Division of Nephrology, Veterans Affairs New York Healthcare System and New York University School of Medicine, New York.
authors.forename: James S
authors.initials: JS
authors.lastname: Kaufman
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Robbin
authors.affiliation: Division of Nephrology, University of Utah, Salt Lake City, Utah.
authors.forename: Yan-Ting
authors.initials: YT
authors.lastname: Shiu
authors.affiliation: Division of Nephrology, University of Utah, Salt Lake City, Utah.
authors.forename: Christi M
authors.initials: CM
authors.lastname: Terry
authors.affiliation: Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Heidi R
authors.initials: HR
authors.lastname: Umphrey
authors.affiliation: Division of Nephrology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D001808:Blood Vessels / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D016896:Treatment Outcome
keywords: arteriovenous access; arteriovenous fistula; vascular access