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Multicenter Study
. 2014 Jan;63(1):104-12.
doi: 10.1053/j.ajkd.2013.06.024. Epub 2013 Aug 28.

Objectives and design of the hemodialysis fistula maturation study

Laura M Dember  1 , Peter B Imrey  2 , Gerald J Beck  2 , Alfred K Cheung  3 , Jonathan Himmelfarb  4 , Thomas S Huber  5 , John W Kusek  6 , Prabir Roy-Chaudhury  7 , Miguel A Vazquez  8 , Charles E Alpers  9 , Michelle L Robbin  10 , Joseph A Vita  11 , Tom Greene  12 , Jennifer J Gassman  2 , Harold I Feldman  13 ; Hemodialysis Fistula Maturation Study Group
Collaborators, Affiliations
Multicenter Study

Objectives and design of the hemodialysis fistula maturation study

Laura M Dember et al. Am J Kidney Dis. 2014 Jan.

Abstract

Background: A large proportion of newly created arteriovenous fistulas cannot be used for dialysis because they fail to mature adequately to support the hemodialysis blood circuit. The Hemodialysis Fistula Maturation (HFM) Study was designed to elucidate clinical and biological factors associated with fistula maturation outcomes.

Study design: Multicenter prospective cohort study.

Setting & participants: Approximately 600 patients undergoing creation of a new hemodialysis fistula will be enrolled at 7 centers in the United States and followed up for as long as 4 years.

Predictors: Clinical, anatomical, biological, and process-of-care attributes identified pre-, intra-, or postoperatively.

Outcomes: The primary outcome is unassisted clinical maturation, defined as successful use of the fistula for dialysis for 4 weeks without maturation-enhancing procedures. Secondary outcomes include assisted clinical maturation, ultrasound-based anatomical maturation, fistula procedures, fistula abandonment, and central venous catheter use.

Measurements: Preoperative ultrasound arterial and venous mapping, flow-mediated and nitroglycerin-mediated brachial artery dilation, arterial pulse wave velocity, and venous distensibility; intraoperative vein tissue collection for histopathologic and molecular analyses; postoperative ultrasounds at 1 day, 2 weeks, 6 weeks, and prior to fistula intervention and initial cannulation.

Results: Assuming complete data, no covariate adjustment, and unassisted clinical maturation of 50%, there will be 80% power to detect ORs of 1.83 and 1.61 for dichotomous predictor variables with exposure prevalences of 20% and 50%, respectively.

Limitations: Exclusion of 2-stage transposition fistulas limits generalizability. The requirement for study visits may result in a cohort that is healthier than the overall population of patients undergoing fistula creation.

Conclusions: The HFM Study will be of sufficient size and scope to: (1) evaluate a broad range of mechanistic hypotheses, (2) identify clinical practices associated with maturation outcomes, (3) assess the predictive utility of early indicators of fistula outcome, and (4) establish targets for novel therapeutic interventions to improve fistula maturation.

Keywords: Vascular access; arteriovenous fistula; observational.

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References

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    1. U.S. Renal Data System. USRDS 2011 Annual Data Report: Atlas of Chonic Kidney Disease and End-Stage Renal Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; Bethesda, MD: 2011.
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