title: The closure of arteriovenous fistula in kidney transplant recipients is associated with an acceleration of kidney function decline.
abstract: The creation of arteriovenous fistula (AVF) may retard chronic kidney disease progression in the general population. Conversely, the impact of AVF closure on renal function in kidney transplant recipients (KTRs) remains unknown.
  
  
  
  From 2007 to 2013, we retrospectively categorized 285 KTRs into three groups: no AVF (Group 0, n = 90), closed AVF (Group 1, n = 114) and left-open AVF (Group 2, n = 81). AVF closure occurred at 653 ± 441 days after kidney transplantation (KTx), with a thrombosis:ligation ratio of 19:95. Estimated glomerular filtration rate (eGFR) was determined using the Modification of Diet in Renal Disease equation. Linear mixed models calculated the slope and intercept of eGFR decline versus time, starting at 3 months post-KTx, with a median follow-up of 1807 days (95% confidence interval 1665-2028).
  
  
  
  The eGFR slope was less in Group 1 (-0.081 mL/min/month) compared with Group 0 (-0.183 mL/min/month; P = 0.03) or Group 2 (-0.164 mL/min/month; P = 0.09). Still, the eGFR slope significantly deteriorated after (-0.159 mL/min/month) versus before (0.038 mL/min/month) AVF closure (P = 0.03). Study periods before versus after AVF closure were balanced to a mean of 13.5 and 12.5 months, respectively, with at least 10 observations per patient ( n = 99).
  
  
  
  In conclusion, a significant acceleration of eGFR decline is observed over the 12 months following the closure of a functioning AVF in KTRs.
authors: Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium.
authors: Laurent
authors: L
authors: Weekers
authors: Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium.
authors: Pauline
authors: P
authors: Vanderweckene
authors: KU Leuven Kulak, Department of Public Health and Primary Care, University of Leuven, Kortrijk, Belgium.
authors: Hans
authors: H
authors: Pottel
authors: Intensive Care Unit, Cliniques universistaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
authors: Diego
authors: D
authors: Castanares-Zapatero
authors: Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium.
authors: Catherine
authors: C
authors: Bonvoisin
authors: Division of Abdominal Surgery and Transplantation, Department of Surgery, University of Liège Hospital (ULg CHU), Liège, Belgium.
authors: Etienne
authors: E
authors: Hamoir
authors: Division of Abdominal Surgery and Transplantation, Department of Surgery, University of Liège Hospital (ULg CHU), Liège, Belgium.
authors: Sylvie
authors: S
authors: Maweja
authors: Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium.
authors: Jean-Marie
authors: JM
authors: Krzesinski
authors: Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium.
authors: Pierre
authors: P
authors: Delanaye
authors: Division of Nephrology, Department of Internal Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium.|Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of Liège, Liège, Belgium.
authors: François
authors: F
authors: Jouret
mesh_terms: D000328:Adult; D001164:Arteriovenous Fistula / Q000209:etiology / Q000473:pathology*; D001166:Arteriovenous Shunt, Surgical / Q000379:methods*; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000473:pathology*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000628:therapy*; D012189:Retrospective Studies; D066027:Transplant Recipients
keywords: GFR; MDRD; arteriovenous fistula; graft function; kidney transplantation