Association of Anatomical Location and Preoperative Blood Biomarkers With Arteriovenous Fistula Maturation in Hemodialysis Patients.

Abstract

Introduction: Arteriovenous fistulas (AVFs) are the best choice for providing vascular access for hemodialysis patients. AVF maturation is essential for successful hemodialysis. However, up to 60% of AVFs fail to mature due to multiple risk factors. Thus, this study is aimed at investigating the association of anatomical location and preoperative blood parameters with AVF maturity. Methods: This is a retrospective cohort study of 206 patients who underwent their first AVF creation at the Hasheminejad Kidney Center, Tehran, Iran, from January 2016 to January 2019. Demographic and clinical characteristics and blood biomarkers were recorded for all patients preoperatively. Results: The total maturation rate was 67.2%. The primary failure rate of AVFs was 5.8%. Regarding AVF location, wrist fistulas had a higher rate of maturation than antecubital fistulas (73.2% vs. 55.9%, p = 0.013, OR = 2.15). The WBC (p = 0.03), RBC (p = 0.008), and hemoglobin (p = 0.009) levels were lower in the matured AVFs than in the nonmatured groups. Most kidney function biomarkers were not significantly related to AVF maturation. However, the mature wrist AVFs had lower levels of albumin and calcium-phosphorus index. The wrist AVF in patients with calcium levels under 8.5 mg/dL worked more efficiently than antecubital group (76.4% vs. 52.9%, p = 0.015, OR = 2.87). Conclusion: This study supports the evidence that wrist AVF could be a preferred AVF choice in the patients who met its clinical criteria.