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. 2019 May 11;13(1):116-122.
doi: 10.1093/ckj/sfz048. eCollection 2020 Feb.

Arteriovenous fistula thrombosis is associated with increased all-cause and cardiovascular mortality in haemodialysis patients from the AURORA trial

Sophie Girerd  1   2   3 , Nicolas Girerd  2   3 , Luc Frimat  1   3 , Hallvard Holdaas  4 , Alan G Jardine  5 , Roland E Schmieder  6 , Bengt Fellström  7 , Nicla Settembre  8 , Sergei Malikov  8 , Patrick Rossignol  2   3 , Faiez Zannad  2   3
Affiliations

Arteriovenous fistula thrombosis is associated with increased all-cause and cardiovascular mortality in haemodialysis patients from the AURORA trial

Sophie Girerd et al. Clin Kidney J. .

Abstract

Background: The impact of arteriovenous fistula (AVF) or graft (AVG) thrombosis on mortality has been sparsely studied. This study investigated the association between AVF/AVG thrombosis and all-cause and cardiovascular mortality.

Methods: The data from 2439 patients with AVF or AVG undergoing maintenance haemodialysis (HD) included in the A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events trial (AURORA) were analysed using a time-dependent Cox model. The incidence of vascular access (VA) thrombosis was a pre-specified secondary outcome.

Results: During follow-up, 278 AVF and 94 AVG thromboses were documented. VA was restored at 22 ± 64 days after thrombosis (27 patients had no restoration with subsequent permanent central catheter). In multivariable survival analysis adjusted for potential confounders, the occurrence of AVF/AVG thrombosis was associated with increased early and late all-cause mortality, with a more pronounced association with early all-cause mortality {hazard ratio [HR] < 90 days 2.70 [95% confidence interval (CI) 1.83-3.97], P < 0.001; HR > 90 days 1.47 [1.20-1.80], P < 0.001}. In addition, the occurrence of AVF thrombosis was significantly associated with higher all-cause mortality, whether VA was restored within 7 days [HR 1.34 (95% CI 1.02-1.75), P = 0.036] or later than 7 days [HR 1.81 (95% CI 1.29-2.53), P = 0.001].

Conclusions: AVF/AVG thrombosis should be considered as a major clinical event since it is strongly associated with increased mortality in patients on maintenance HD, especially in the first 90 days after the event and when access restoration occurs >7 days after thrombosis. Clinicians should pay particular attention to the timing of VA restoration and the management of these patients during this high-risk period. The potential benefit of targeting overall patient risk with more aggressive treatment after AVF/AVG restoration should be further explored.

Keywords: arteriovenous fistula; arteriovenous graft; cardiovascular mortality; chronic haemodialysis; survival; vascular access complication.

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Figures

FIGURE 1
FIGURE 1
Death-censored survival free of VA complications during follow-up according to the type of VA (AVF or AVG).
FIGURE 2
FIGURE 2
Association in multivariable analysis [adjusted for age, gender, years on RRT, type of VA (when applicable), current smoking, diabetes, history of coronary disease, history of peripheral arterial disease, BMI, systolic blood pressure, calculated Kt/V, albumin level, haemoglobin level and hsCRP level (at baseline), platelet inhibitors and rosuvastatin] between VA complications and (A) all-cause and (B) CV mortality, as well as on (C) the composite endpoint of death from CV causes, non-fatal myocardial infarction or non-fatal stroke according to type of VA and type of complication. Results are presented as HR with 95% CIs. NA, not available.
See this image and copyright information in PMC

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