Evaluating the impact of Arteriovenous Fistula (AVF) creation on kidney function.

Background: Arteriovenous fistula (AVF) creation may slow down the decline of kidney function as shown in few previous studies. Our aim was to evaluate the effect of AVF creation on kidney function and dialysis initiation in predialysis patients.

Methods: Predialysis patients with AVFs and estimated glomerular filtration rate (eGFR) recorded on day of AVF creation and at 12 and 6 months pre- and post-AVF creation were identified. Rate of decline (RoD) of eGFR and Kidney Failure Risk Equation Score (KFRE) was recorded pre- and post-AVF creation at 6 and 12 months. Patients with non-functioning AVFs were identified and RoD was compared to functioning AVFs. Patients undergoing haemodialysis pre- and post-AVF creation were identified.

Results: Overall, 368 patients and 435 patients were identified for the 12-month and 6-month group, respectively. Rate of decline of eGFR 6 months pre-AVF creation was -0.33 ml/min/1.73m2/month which slowed down to -0.23 ml/min/1.73m2/month in the 6 months post-AVF creation. Rate of decline of eGFR 12 months pre-AVF creation was -0.37 ml/min/1.73m2/month and slowed down to -0.19 ml/min/1.73m2/month in the 12 months post-AVF creation. KFRE increased at a slower rate at 6 and 12 months post-AVF. One hundred sixty-two patients had functioning AVFs while 29 patients had non-functioning AVFs at 6 months post-AVF creation. Rate of decline of eGFR in patients with functioning AVF was -0.22 ml/min/1.73m2/month compared to -0.32 ml/min/1.73m2/month in patients with non-functioning AVF; 246 patients (62.3%) were commenced on haemodialysis in the 12 months pre- and post- AVF creation.

Conclusion: AVF creation was associated with a slower rate of decline of kidney function. However, this is unlikely to delay the commencement of haemodialysis in predialysis patients.