Predictive Factors for Unsuccessful Use of Arteriovenous Fistula in a Population of End-Stage Renal Disease Patients in Southeastern Mexico.

BACKGROUND

An arteriovenous fistula (AVF) is the preferred vascular access for long-term hemodialysis. The main disadvantage of AVF is the rate of nonmaturation or unsuccessful use for hemodialysis (FUHD). We described our findings in AVF creation and possible risk factors associated with FUHD.

METHODS

This is a retrospective study of AVFs during a 6-year period. Variables collected at the time of creation were demographics, comorbidities, replacement therapy, preoperative laboratory tests, and estimated 6-month mortality on hemodialysis. All AVFs were created in the upper arms. Outcomes were FUHD, cannulation failure, and cumulative survival. Univariate and multivariate analyses were performed to find possible risk factors for FUHD.

RESULTS

AVFs were created in 78 patients. Average age was 36.3 years, and 74.4% were male. Mean body mass index was 24.5 kg/m. The most common etiologies were glomerulopathy (53.6%) and diabetes mellitus (13.4%). Estimated six-month mortality was 4.2%. One patient underwent AVF before hemodialysis (mean dialysis time 2.2 years). Nineteen AVFs were considered FUHD (23.2%). Cannulation failure was 15.9%. AVF 1-year and 3-year survival was 67.8% and 63.5%, respectively. FUHD had higher estimated six-month mortality on hemodialysis, shorter prothrombin time, and lower serum albumin level than successful AVF (univariate analysis) (P < 0.05) Short prothrombin time and albumin were confirmed for FUHD (multivariate analysis). A 3.3-gr/dL serum albumin cutoff point (area under the curve, 0.715; receiver operating characteristic) (P < 0.05) was determined for FUHD.

CONCLUSIONS

The population referred for AVF creation possesses different characteristics in our center. Good AVF outcomes can be achieved. Preoperative serum albumin level and prothrombin time could be the possible risk factors associated with unsuccessful AVF use.