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. 2024 Mar-Apr;37(2):161-171.
doi: 10.1111/sdi.13179. Epub 2023 Sep 25.

Effectiveness of a native vein arteriovenous fistula tracking system

Lingyan Meng  1   2 , Jun Jie Ng  1   2 , Andrew Mark Tze Liang Choong  1   2 , Rajesh Babu Dharmaraj  2 , Raj Menon  2 , Julian Chi Leung Wong  2 , Susan Ching  2 , Yen Feng Wong  2 , Jaqueline Kong  2 , Pei Ho  1   2
Affiliations

Effectiveness of a native vein arteriovenous fistula tracking system

Lingyan Meng et al. Semin Dial. 2024 Mar-Apr.

Abstract

Objective: This study aims to evaluate the effectiveness of a tracking program on the functional maturation rate of arteriovenous fistula (AVF).

Methods: Two major clinical outcomes (commencement of cannulation and functional maturation) of created AVFs were compared between two cohorts. (i) Cohort 1: historical cohort; (ii) Cohort 2: AVFs created after implementation of the tracking project. Multivariable Cox regression models were used to assess the association between cohort allocation and the two major clinical outcomes.

Results: Data of 114 and 141 patients were analyzed respectively from Cohorts 1 (historical data) and 2 (with AVF tracking). After adjustment of covariates in the multivariable analysis, the AVFs created in Cohort 2 were more likely to be cannulated earlier (adjusted HR: 2.82; 95% CI: 1.97-4.05; p < 0.001), compared to those in Cohort 1. Similarly, the AVFs of Cohort 2 patients had significantly higher probability of functional maturation (adjusted HR: 1.81; 95% CI: 1.31-2.48; p < 0.001) than fistulas in Cohort 1. Cannulation was commenced for half of the AVFs by 4.1 months post-creation in the historical cohort (Cohort 1), whereas in the post-tracking cohort, 50% of the AVFs were cannulated by 2.3 months after creation (p < 0.001). It took 5.5 and 4.3 months for 50% of the AVFs created in Cohort 1 and Cohort 2 patients to achieve catheter-free functional maturation, respectively (p = 0.06).

Conclusion: An AVF tracking program with maturation target for the access surgeons, together with a standardized tracking, feedback, and clinical strategy adjustment system is able to improve the AVF functional maturation rate.

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