Introduction
Methods
Patient selection
Data collection
Outcomes and candidate predictors
Statistical analysis
Results
Patient characteristics and VA configurations
RCAVF | Upper arm AVF | AVG |
p value | |||
---|---|---|---|---|---|---|
RCAVF versus other | Upper arm AVF versus other | AVG versus other | ||||
Number of accesses n = 1605 | 663 | 699 | 243 | |||
Gender | ||||||
Male | 463 (69.8%) | 363 (51.9%) | 108 (44.4%) | <0.001 | <0.001 | <0.001 |
Female | 200 (30.2%) | 336 (48.1%) | 135 (55.6%) | |||
Patient age | 62.6 ± 15.3 year | 62.7 ± 14.6 year | 64.3 ± 14.9 year | 0.516 | 0.624 | 0.116 |
Body mass index (BMI) | 27.1 ± 5.9 kg/m2
| 26.5 ± 6.2 kg/m2
| 27.6 ± 6.5 kg/m2
| 0.288 | 0.017 | 0.066 |
Mean arterial pressure at VA creation | 103 ± 16.4 mmHg | 96 ± 17.3 mmHg | 96 ± 18.4 mmHg | <0.001 | <0.001 | 0.003 |
First permanent vascular access for patient | 596 (89.9%) | 414 (59.2%) | 113 (46.5%) | <0.001 | <0.001 | <0.001 |
Preemptively created | 366 (55.2%) | 274 (39.2%) | 83 (34.2%) | <0.001 | <0.001 | <0.001 |
Jugular catheter present | <0.001 | <0.001 | 0.263 | |||
No catheter | 381 (57.5%) | 301 (43.1%) | 108 (44.4%) | |||
Ipsilateral catheter | 100 (15.1%) | 145 (20.7%) | 50 (20.6%) | |||
Contralateral catheter | 182 (27.5%) | 253 (36.2%) | 85 (35.0%) | |||
Preoperative ultrasound | ||||||
Target vein diameter | 2.9 ± 0.8 mm | 3.9 ± 1.3 mm | 3.9 ± 1.4 mm | <0.001 | <0.001 | <0.001 |
Artery diameter | 2.6 ± 0.6 mm | 4.3 ± 1.1 mm | 4.5 ± 1.0 mm | <0.001 | <0.001 | <0.001 |
Cause of renal failure | 0.163 | 0.092 | 0.112 | |||
Diabetes mellitus | 132 (19.9%) | 165 (23.6%) | 72 (29.6%) | |||
Glomerulonephritis | 72 (10.9%) | 80 (11.4%) | 22 (9.1%) | |||
Vascular disease | 147 (22.2%) | 140 (20.0%) | 52 (21.4%) | |||
Interstitial nephropathy | 43 (6.5%) | 48 (6.9%) | 14 (5.8%) | |||
Cystic kidney disease | 50 (7.5%) | 34 (4.9%) | 14 (5.8%) | |||
Congenital/hereditary disease | 17 (2.6%) | 21 (3.0%) | 7 (2.9%) | |||
Multisystem disease | 29 (4.4%) | 39 (5.6%) | 5 (2.1%) | |||
Other | 91 (13.7%) | 109 (15.6%) | 27 (11.1%) | |||
Unknown | 82 (12.4%) | 63 (9.0%) | 30 (12.3%) | |||
Comorbid conditions | ||||||
Diabetes mellitus | 242 (36.5%) | 282 (40.3%) | 128 (52.7%) | 0.005 | 0.841 | <0.001 |
Coronary artery disease | 173 (26.1%) | 182 (26.0%) | 59 (24.3%) | 0.818 | 0.845 | 0.558 |
Peripheral vascular disease | 125 (18.9%) | 127 (18.2%) | 41 (16.9%) | 0.603 | 0.937 | 0.545 |
Cerebrovascular disease | 94 (14.2%) | 97 (13.9%) | 39 (16.0%) | 0.844 | 0.649 | 0.406 |
Medication use | ||||||
Antiplatelet | 227 (34.2%) | 238 (34.0%) | 77 (31.7%) | 0.739 | 0.835 | 0.456 |
Anticoagulant | 100 (15.1%) | 139 (19.9%) | 47 (19.3%) | 0.016 | 0.057 | 0.501 |
ACE inhibitor | 244 (36.8%) | 240 (34.3%) | 83 (34.2%) | 0.300 | 0.465 | 0.679 |
Angiotensin receptor blocker | 197 (29.7%) | 188 (26.9%) | 62 (25.5%) | 0.162 | 0.453 | 0.378 |
Calcium channel blocker | 292 (44.0%) | 340 (48.6%) | 113 (46.5%) | 0.109 | 0.117 | 0.977 |
Aldosterone antagonist | 15 (2.3%) | 9 (1.3%) | 4 (1.6%) | 0.184 | 0.219 | 0.899 |
Phosphate binder non-calcium based | 346 (52.2%) | 400 (57.2%) | 151 (62.1%) | 0.012 | 0.343 | 0.033 |
Phosphate binder calcium based | 282 (42.5%) | 259 (37.1%) | 105 (43.2%) | 0.117 | 0.022 | 0.307 |
Vitamin D | 519 (78.3%) | 558 (79.8%) | 187 (77.0%) | 0.697 | 0.355 | 0.457 |
Corticosteroids | 59 (8.9%) | 97 (13.9%) | 23 (9.5%) | 0.016 | 0.002 | 0.364 |
Other immunosuppressant | 19 (2.9%) | 51 (7.3%) | 9 (3.7%) | 0.001 | <0.001 | 0.341 |
Laboratory measurements | ||||||
Calcium | 2.28 ± 0.18 mmol/l | 2.27 ± 0.19 mmol/l | 2.25 ± 0.20 mmol/l | 0.191 | 0.670 | 0.234 |
Phosphate | 1.67 ± 0.51 mmol/l | 1.67 ± 0.54 mmol/l | 1.65 ± 0.48 mmol/l | 0.751 | 0.983 | 0.681 |
PTH | 37.2 ± 46.6 pmol/l | 35.7 ± 38.3 mmol/l | 31.5 ± 25.3 mmol/l | 0.273 | 0.999 | 0.138 |
HbA1c-IFCC | 44.5 ± 13.5 mmol/mol | 45.1 ± 13.2 mmol/mol | 44.8 ± 16.3 mmol/mol | 0.635 | 0.615 | 0.960 |
VA configuration (n) n = 1605 | On HD at time of VA creation | First access for patient | ||
---|---|---|---|---|
Yes | No but started within 3 months | No started after 3 months or never | ||
RCAVF (663) | 44.8% (297) | 16.6% (110) | 38.6% (256) | 89.9% (596) |
BCAVF (547) | 56.5% (309) | 17.4% (95) | 26.1% (143) | 62.9% (344) |
BBAVF (152) | 76.3% (116) | 8.6% (13) | 15.1% (23) | 46.1% (70) |
AVG (243) | 65.8% (160) | 18.1% (44) | 16.0% (39) | 46.5% (113) |
Incidence of nonmaturation
Patients on HD at time of VA creation | Started HD within 3 months | All VAs with known outcome n = 1496 | |||
---|---|---|---|---|---|
Use at 6 weeks | Use at 3 months | Time until use (days ± SD) | Use at 3 months | AVF nonmaturation/AVG functional failure | |
RCAVF | 17.4% (50/287) | 61.3% (176/287) | 68 ± 44 | 81.1% (86/106) | 24.1% (149/617) |
Upper arm AVF | 22.0% (89/404) | 72.5% (293/404) | 66 ± 43 | 93.5% (100/107) | 10.6% (69/650) |
AVG | 71.0% (110/155) | 91.6% (142/155) | 31 ± 19 | 97.6% (41/42) | 5.7% (13/229) |
Prediction of nonmaturation
Variable | Beta | Odds ratio (95% confidence interval) |
p
|
---|---|---|---|
Preoperative cephalic vein diameter <2.5 mm | 0.426 | 1.53 (1.01–2.32) | 0.044 |
Female gender | 0.787 | 2.20 (1.47–3.29) | <0.001 |
Peripheral vascular disease | 0.326 | 1.39 (0.84–2.28) | 0.198 |
Cerebrovascular disease | −0.784 | 0.46 (0.23–0.89) | 0.022 |