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. 2024 Nov 1;35(11):1570-1573.
doi: 10.1681/ASN.0000000000000443. Epub 2024 Jul 8.

Arteriovenous Access Creation and eGFR Decline in Patients with CKD

Abdel-Hay Tabcheh  1 , Raphaël Coscas  1   2 , Oriane Lambert  1 , Bénédicte Stengel  1 , Luc Frimat  3   4 , Ziad Massy  1   5   6 , Christian Combe  7   8 , Murilo Guedes  9   10 , Roberto Pecoits-Filho  9   10 , Julie Boucquemont  1 , Natalia Alencar De Pinho  1 ; CKD-REIN Study Collaborators
Collaborators, Affiliations

Arteriovenous Access Creation and eGFR Decline in Patients with CKD

Abdel-Hay Tabcheh et al. J Am Soc Nephrol. .
No abstract available

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Conflict of interest statement

Disclosure forms, as provided by each author, are available with the online version of the article at http://links.lww.com/JSN/E758.

Figures

Figure 1
Figure 1
Changes in the predicted eGFR trajectory within the 2-year window before and after arteriovenous access creation (N=415 participants). (A) eGFR trajectory and (B) corresponding eGFR slope estimated with a piecewise linear mixed-effects model; (C) eGFR trajectory and (D) corresponding eGFR slope estimated with a restricted cubic spline mixed-effects model with random intercept and independent spline coefficients, knots at −12, 0, and +6 months. Bold black lines and colored lines correspond to population-averaged and participant-specific estimates, respectively. The dotted red line indicates the moment of AV access creation, which was deliberately chosen as the landmark for a potential change in the eGFR slope in the piecewise linear model (i.e., a breakpoint in the slope's continuity). The bold red dot indicates the inflection point of the population-averaged spline eGFR trajectory in the restricted cubic spline mixed-effects model. The mean (population-averaged) time interval (95% CI) from the eGFR inflection point to AV access creation was 8.1 (6.4 to 9.0) months. The corresponding mean (95% CI) eGFR level was 17 (16 to 18) ml/min per 1.73 m2, and the mean (95% CI) instantaneous eGFR decline, 5.5 (5.1 to 5.8) ml/min per 1.73 m2 per year. These estimates are based on a spline model that allows for two inflection points: one in the time window between −12 and 0 months and the other in the time window between 0 and +6 months. Any other potential inflection points outside these time windows could not be identified by our analysis. Participant-specific trajectories with less than two eGFR observations before and two observations after AV access creation were not represented in the figure. We compared the models, both of which were estimated with a restricted maximum likelihood approach, using the conditional Akaike information criterion. The value of this criterion was much lower (and thus more favorable) in the restricted cubic spline analysis than in the piecewise linear analysis (41,258 versus 41,586, respectively). Owing to computational considerations for the spline model, our models assumed independent random intercepts, linear slopes, and spline coefficients, which is likely unrealistic. However, completely relaxing this assumption in the piecewise linear model only negligibly changed the results, and the cubic spline model may be similarly robust. The 95% CIs were built with nonparametric patient-level bootstrapping and 1000 simulations. For further details of the models' specifications, please refer to the Supplemental Equations 1 and 2. AV, arteriovenous; CI, confidence interval.
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