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Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease.

Bashar K, Zafar A, Elsheikh S, Healy DA, Clarke-Moloney M, Casserly L, Burke PE, Kavanagh EG, Walsh SR - PLoS ONE (2015)

Bottom Line: Female gender showed significant association with nonmaturation (P = 0.004) and was the only predictor for non-maturation in a logistic regression model (P = 0.011).Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation.In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.

ABSTRACT

Introduction: With increasing numbers of patients diagnosed with ESRD, arteriovenous fistula (AVF) maturation has become a major factor in improving both dialysis related outcomes and quality of life of those patients. Compared to other types of access it has been established that a functional AVF access is the least likely to be associated with thrombosis, infection, hospital admissions, secondary interventions to maintain patency and death.

Aim: Study of demographic factors implicated in the functional maturation of arteriovenous fistulas. Also, to explore any possible association between preoperative haematological investigations and functional maturation.

Methods: We performed a retrospective chart review of all patients with ESRD who were referred to the vascular service in the University Hospital of Limerick for creation of vascular access for HD. We included patients with primary AVFs; and excluded those who underwent secondary procedures.

Results: Overall AVF functional maturation rate in our study was 53.7% (52/97). Female gender showed significant association with nonmaturation (P = 0.004) and was the only predictor for non-maturation in a logistic regression model (P = 0.011). Patients who had history of renal transplant (P = 0.036), had relatively lower haemoglobin levels (P = 0.01) and were on calcium channel blockers (P = 0.001) showed better functional maturation rates.

Conclusion: Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation. In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.

No MeSH data available.


Related in: MedlinePlus

Variation in age between mature and non-mature AVF groups.
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pone.0119958.g004: Variation in age between mature and non-mature AVF groups.

Mentions: We examined the relationship between different patients’ characteristics, comorbidities and drug therapy and functional maturation in our patients using the appropriate statistical tests as outlined above; 40/59 (67.8%) fistulas matured in men while 9/26 (34.6%) matured in female patients; this difference was statistically significant (P = 0.004) suggesting female gender is associated with poor functional maturation. Age was not distributed equally among patients with a documented maturation outcome; however it was not found to be statistically associated with functional maturation as those who were found to have a functional access aged (62.4 ± 13.9) compared to (60 ± 20) in patients who could not dialyse from their AVFs (P = 0.926; Mann-Whitney U test) [Fig. 4]. Hypertension was diagnosed in 72 cases; 44 (61.1%) of those matured, whereas of the 13 cases who did not suffer from hypertension five (38.5%) fistulas matured (P = 0.128). Of the 34 fistulas with a positive diagnosis of diabetes 18 fistulas of those matured whereas 16 did not mature, compared to 31 and 20 respectively of the 51 patients who had a documented different aetiology for ESRD. The difference between the two groups of patients was not significant (P = 0.473). The use of Insulin for the treatment of diabetes also did not correlate significantly to functional maturation (P = 0.839).


Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease.

Bashar K, Zafar A, Elsheikh S, Healy DA, Clarke-Moloney M, Casserly L, Burke PE, Kavanagh EG, Walsh SR - PLoS ONE (2015)

Variation in age between mature and non-mature AVF groups.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4358953&req=5

pone.0119958.g004: Variation in age between mature and non-mature AVF groups.
Mentions: We examined the relationship between different patients’ characteristics, comorbidities and drug therapy and functional maturation in our patients using the appropriate statistical tests as outlined above; 40/59 (67.8%) fistulas matured in men while 9/26 (34.6%) matured in female patients; this difference was statistically significant (P = 0.004) suggesting female gender is associated with poor functional maturation. Age was not distributed equally among patients with a documented maturation outcome; however it was not found to be statistically associated with functional maturation as those who were found to have a functional access aged (62.4 ± 13.9) compared to (60 ± 20) in patients who could not dialyse from their AVFs (P = 0.926; Mann-Whitney U test) [Fig. 4]. Hypertension was diagnosed in 72 cases; 44 (61.1%) of those matured, whereas of the 13 cases who did not suffer from hypertension five (38.5%) fistulas matured (P = 0.128). Of the 34 fistulas with a positive diagnosis of diabetes 18 fistulas of those matured whereas 16 did not mature, compared to 31 and 20 respectively of the 51 patients who had a documented different aetiology for ESRD. The difference between the two groups of patients was not significant (P = 0.473). The use of Insulin for the treatment of diabetes also did not correlate significantly to functional maturation (P = 0.839).

Bottom Line: Female gender showed significant association with nonmaturation (P = 0.004) and was the only predictor for non-maturation in a logistic regression model (P = 0.011).Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation.In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.

View Article: PubMed Central - PubMed

Affiliation: Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland.

ABSTRACT

Introduction: With increasing numbers of patients diagnosed with ESRD, arteriovenous fistula (AVF) maturation has become a major factor in improving both dialysis related outcomes and quality of life of those patients. Compared to other types of access it has been established that a functional AVF access is the least likely to be associated with thrombosis, infection, hospital admissions, secondary interventions to maintain patency and death.

Aim: Study of demographic factors implicated in the functional maturation of arteriovenous fistulas. Also, to explore any possible association between preoperative haematological investigations and functional maturation.

Methods: We performed a retrospective chart review of all patients with ESRD who were referred to the vascular service in the University Hospital of Limerick for creation of vascular access for HD. We included patients with primary AVFs; and excluded those who underwent secondary procedures.

Results: Overall AVF functional maturation rate in our study was 53.7% (52/97). Female gender showed significant association with nonmaturation (P = 0.004) and was the only predictor for non-maturation in a logistic regression model (P = 0.011). Patients who had history of renal transplant (P = 0.036), had relatively lower haemoglobin levels (P = 0.01) and were on calcium channel blockers (P = 0.001) showed better functional maturation rates.

Conclusion: Female gender was found to be associated with functional non-maturation, while a history kidney transplant, calcium channel-blocker agents and low haemoglobin levels were all associated with successful functional maturation. In view of the conflicting evidence in the literature, large prospective multi-centre registry-based studies with well-defined outcomes are needed.

No MeSH data available.


Related in: MedlinePlus