Predictors of successful arteriovenous fistula maturation

Abstract

Background: Understanding the factors associated with successful arteriovenous fistula (AVF) maturation may provide an opportunity to improve vascular access outcomes.

Methods: This prospective cohort study enrolled 348 hemodialysis patients receiving an AVF and followed them until ascertainment of successful AVF maturation. Multivariable logistic regression was used to develop (1) explanatory models of factors associated with AVF success and (2) models for predicting success based on sociodemographic and comorbidity profiles. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminative ability of our predictive model. Predictive probabilities of AVF maturation under the assumption of optimal surgical technique defined by explanatory models were calculated.

Results: A total of 55.5% of AVFs successfully matured. A history of stroke or transient ischemic attack, increasing age, and dependence on dialysis at the time of access placement were associated with lower probabilities of maturation. Of potentially modifiable variables, maturation was associated with greater intraoperative doses of heparin, use of large-diameter veins, and mean arterial pressure of 85 mm Hg or greater. Using optimal surgical technique, the probability of successful AVF maturation would have been as high as 84%. A predictive logistic regression model had moderate ability to predict AVF maturation under optimal surgical therapy with an area under the ROC curve of 0.69.

Conclusion: Surgical technique potentially may be modified to yield a greater probability of successful AVF maturation. Predictive probabilities of successful AVF maturation under optimal surgical technique reinforce the view that functioning AVFs can be achieved in a large proportion of hemodialysis patients, consistent with experience in selected regions of the United States and abroad.