title: Arteriovenous fistula maturation in patients with permanent access created prior to or after hemodialysis initiation.
abstract: BACKGROUND
  Multiple factors and comorbidities have been implicated in the ability of arteriovenous fistulas (AVF) to mature, including vessel anatomy, advanced age, and the presence of coronary artery disease or peripheral vascular disease. However, little is known about the role of uremia on AVF primary failure. In this study, we attempt to evaluate the effect of uremia on AVF maturation by comparing AVF outcomes between pre-dialysis chronic kidney disease (CKD) stage five patients and those who had their AVF created after hemodialysis (HD) initiation.
  
  
  METHODS
  We included 612 patients who underwent AVF creation between 2003 and 2015 at the University of Miami Hospital and Jackson Memorial Hospital. Effects of uremia on primary failure were evaluated using univariate statistical comparisons and multivariate logistic regression analyses.
  
  
  RESULTS
  Primary failure occurred in 28.1% and 26.3% of patients with an AVF created prior to or after HD initiation, respectively (p = 0.73). The time of HD initiation was not associated with AVF maturation in multivariate logistic regression analysis (p = 0.57). In addition, pre-operative blood urea nitrogen (p = 0.78), estimated glomerular filtration rate (p = 0.66), and serum creatinine levels (p = 0.14) were not associated with AVF primary failure in pre-dialysis patients.
  
  
  CONCLUSIONS
  Our results show that clearance of uremia with regular HD treatments prior to AVF creation does not improve the frequency of vascular access maturation.
authors.affiliation: Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida - USA.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Duque
authors.affiliation: DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida - USA.
authors.forename: Laisel
authors.initials: L
authors.lastname: Martinez
authors.affiliation: DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida - USA.
authors.forename: Marwan
authors.initials: M
authors.lastname: Tabbara
authors.affiliation: Department of Medicine, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida - USA.
authors.forename: Denise
authors.initials: D
authors.lastname: Dvorquez
authors.affiliation: Department of Medicine, Division of Nephrology, Jersey Shore University Medical Center, Hackensack-Meridian Seton Hall School of Medicine, Neptune, New York - USA.
authors.forename: Sushil K
authors.initials: SK
authors.lastname: Mehandru
authors.affiliation: Department of Medicine, Division of Nephrology, Jersey Shore University Medical Center, Hackensack-Meridian Seton Hall School of Medicine, Neptune, New York - USA.
authors.forename: Arif
authors.initials: A
authors.lastname: Asif
authors.affiliation: DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida - USA.
authors.forename: Roberto I
authors.initials: RI
authors.lastname: Vazquez-Padron
authors.affiliation: Division of Nephrology, Albany Medical College, Albany, New York - USA.
authors.forename: Loay H
authors.initials: LH
authors.lastname: Salman
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D016009:Chi-Square Distribution; D005260:Female; D005431:Florida; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D014511:Uremia / Q000175:diagnosis / Q000628:therapy*
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors