Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2025;54(1):44-53.
doi: 10.1159/000540306. Epub 2024 Sep 26.

Novel Method to Monitor Arteriovenous Fistula Maturation: Impact on Catheter Residence Time

Laura Rosales Merlo  1 , Xiaoling Ye  1 , Hanjie Zhang  1 , Brenda Chan  1 , Marilou Mateo  1 , Seth Johnson  1 , Frank M van der Sande  2 , Jeroen P Kooman  2 , Peter Kotanko  1   3
Affiliations
Multicenter Study

Novel Method to Monitor Arteriovenous Fistula Maturation: Impact on Catheter Residence Time

Laura Rosales Merlo et al. Blood Purif. 2025.

Abstract

Introduction: Arteriovenous fistula (AVF) maturation assessment is essential to reduce venous catheter residence. We introduced central venous oxygen saturation (ScvO2) and estimated upper body blood flow (eUBBF) to monitor newly created fistula maturation and recorded catheter time in patients with and without ScvO2-based fistula maturation.

Methods: From 2017 to 2019, we conducted a multicenter quality improvement project (QIP) in hemodialysis patients with the explicit goal to shorten catheter residence time post-AVF creation through ScvO2-based maturation monitoring. In patients with a catheter as vascular access, we tracked ScvO2 and eUBBF pre- and post-AVF creation. The primary outcome was catheter residence time post-AVF creation. We compared catheter residence time post-AVF creation between QIP patients and controls. One control group comprised concurrent patients; a second control group comprised historic controls (2014-2016). We conducted Kaplan-Meier analysis and constructed a Cox proportional hazards model with variables adjustment to assess time-to-catheter removal.

Results: The QIP group comprised 44 patients (59 ± 17 years), the concurrent control group 48 patients (59 ± 16 years), the historic control group 57 patients (58 ± 15 years). Six-month post-AVF creation, the fraction of non-censored patients with catheter in place was 21% in the QIP cohort, 67% in the concurrent control group, and 68% in the historic control group. In unadjusted and adjusted analysis, catheter residence time post-fistula creation was shorter in QIP patients compared to either control groups (p < 0.001).

Conclusion: ScvO2-based assessment of fistula maturation is associated with shorter catheter residence post-AVF creation.

Keywords: Arteriovenous fistula maturation; Central venous catheter; Central venous oxygen saturation; Hemodialysis; Upper body blood flow; Vascular access.

PubMed Disclaimer

Conflict of interest statement

L.R., X.Y., H.Z., B.C., M.M., S.J., and P.K. are employees of the Renal Research Institute, a wholly owned subsidiary of Fresenius Medical Care. P.K. holds stock in Fresenius Medical Care. The remaining authors declare no conflict of interest. The results presented have not been published previously in whole or part, except in abstract form.

Figures

Fig. 1.
Fig. 1.
Time course of ScvO2 and eUBBF in an uneventful AVF maturation. The period pre-AVF creation is shown in purple, the post-creation time in red. The dashed vertical line indicates the date of AVF creation. The red line ends at first AVF cannulation.
Fig. 2.
Fig. 2.
Time course of ScvO2 and eUBBF changes in a patient with failed AVFF maturation. The period pre-AVF creation is shown in purple, the post-creation time in red. The dashed vertical line indicates the date of AVF creation. The red line ends after the patient was referred for AVF repair.
Fig. 3.
Fig. 3.
Kaplan-Meier cumulative CVC removal curve. Red line: patients in the QIP cohort. Green line: concurrent control patients, i.e., patients treated concurrently with QIP patients in the same clinics. Blue line: historic control patients dialyzed in QIP clinics prior to the start of the QIP (“historic controls”; 2014–2016). Table: the number of patients at risk of resident CVC. The time-to-CVC removal is significantly different between the groups (p < 0.0001, log-rank test).
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Ravani P, Palmer SC, Oliver MJ, Quinn RR, MacRae JM, Tai DJ, et al. . Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol. 2013;24(3):465–73. - PMC - PubMed
    1. Dalrymple LS, Mu Y, Romano PS, Nguyen DV, Chertow GM, Delgado C, et al. . Outcomes of infection-related hospitalization in Medicare beneficiaries receiving in-center hemodialysis. Am J Kidney Dis. 2015;65(5):754–62. - PMC - PubMed
    1. Nguyen DB, Shugart A, Lines C, Shah AB, Edwards J, Pollock D, et al. . National Healthcare Safety Network (NHSN) dialysis event surveillance report for 2014. Clin J Am Soc Nephrol. 2017;12(7):1139–46. - PMC - PubMed
    1. Poinen K, Quinn RR, Clarke A, Ravani P, Hiremath S, Miller LM, et al. . Complications from tunneled hemodialysis catheters: a Canadian observational cohort study. Am J Kidney Dis. 2019;73(4):467–75. - PubMed
    1. Malas MB, Canner JK, Hicks CW, Arhuidese IJ, Zarkowsky DS, Qazi U, et al. . Trends in incident hemodialysis access and mortality. JAMA Surg. 2015;150(5):441–8. - PubMed

Publication types