title: Predictors of Initiation for Predialysis Arteriovenous Fistula.
abstract: The optimal timing of predialysis arteriovenous fistula surgery remains uncertain. We evaluated factors associated with hemodialysis initiation in patients undergoing predialysis arteriovenous fistula surgery and derived a model to predict future initiation of dialysis.
  
  
  
  Our study retrospectively identified 308 patients undergoing predialysis arteriovenous fistula creation at a large medical center in 2006-2012 to determine whether they initiated hemodialysis. Multiple variable logistic regression analyzed which demographic and clinical factors predicted initiation of dialysis within 2 years of arteriovenous fistula surgery. A receiver operating characteristic area under the curve was used to quantify the predictive value of preoperative factors on the likelihood of initiating hemodialysis within 2 years.
  
  
  
  Overall, hemodialysis was initiated within 6 months, 1 year, and 2 years in 119 (39%), 175 (57%), and 211 (68%) patients, respectively. Using multiple variable logistic regression, four factors were associated with hemodialysis initiation at 2 years: eGFR at access surgery (odds ratio, 0.45; 95% confidence interval, 0.31 to 0.64 per 5 ml/min per 1.73 m2;P<0.001), diabetes (odds ratio, 2.51; 95% confidence interval, 1.22 to 5.15;P=0.003), GFR trajectory (odds ratio, 1.54; 95% confidence interval, 1.09 to 2.17 per 3 ml/min per 1.73 m2per year;P=0.01), and spot urine protein-to-creatinine ratio (odds ratio, 1.39; 95% confidence interval, 1.14 to 1.71 per 1 U;P<0.001). eGFR alone had a moderate predictive value for dialysis initiation (area under the curve =0.69; 95% confidence interval, 0.63 to 0.76;P<0.001), whereas the full model had a higher predictive value (area under the curve =0.83; 95% confidence interval, 0.77 to 0.88;P<0.001).
  
  
  
  The likelihood of initiating hemodialysis within 2 years of predialysis arteriovenous fistula surgery is associated with eGFR at access surgery, diabetes, GFR trajectory, and magnitude of proteinuria. The combined use of all four variables improves the ability to predict future hemodialysis compared with the use of eGFR alone.
authors.affiliation: Department of Medicine and Division of Nephrology and.
authors.forename: Alian
authors.initials: A
authors.lastname: Al-Balas
authors.affiliation: Department of Medicine and Division of Nephrology and.|Division of Nephrology, Veterans Affairs Medical Center, Birmingham, Alabama; and.
authors.forename: Timmy
authors.initials: T
authors.lastname: Lee
authors.affiliation: Department of Surgery and Division of Transplantation, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Carlton J
authors.initials: CJ
authors.lastname: Young
authors.affiliation: Department of Microbiology, Montana State University, Bozeman, Montana.
authors.forename: Jill
authors.initials: J
authors.lastname: Barker-Finkel
authors.affiliation: Department of Medicine and Division of Nephrology and.
authors.forename: Michael
authors.initials: M
authors.lastname: Allon
mesh_terms: D000368:Aged; D019540:Area Under Curve; D001166:Arteriovenous Shunt, Surgical / Q000706:statistics & numerical data*; D003404:Creatinine / Q000652:urine; D003920:Diabetes Mellitus / Q000175:diagnosis; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011507:Proteinuria / Q000209:etiology / Q000652:urine; D012372:ROC Curve; D006435:Renal Dialysis / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D003404:Creatinine
keywords: Area Under Curve; Humans; Logistic Models; Probability; ROC Curve; arteriovenous access; arteriovenous fistula; creatinine; diabetes mellitus; glomerular filtration rate; proteinuria; renal dialysis