J PRUNSTER 1, C WILKINSON 1, S DAVIDSON-WEST 1, C CHENG 1, S BHUTIA 1, M MANTHA M1
1Cairns and Hinterland Hospital and Health Service, Cairns, Australia
Aim: To describe early maturation outcomes of native radiocephalic and brachiocephalic arteriovenous fistula (AVF) creations in a single centre.
Background: Native AVF is the preferred mode of access for patients on maintenance haemodialysis. Population cohort studies suggest a primary failure rate of 23% within six months of creation with similar proportions for upper-arm and lower arm AVFs.
Methods: This is a retrospective study of all incident, native radiocephalic and brachiocephalic AVFs created in our centre between January 2018 and December 2020. AVF maturation status was assessed with ultrasound by a single operator at six weeks post creation. The status was defined according to the National Kidney Foundation’s Kidney Disease Outcomes Quality Initiative “rule of sixes” and were categorised as functional, requiring intervention or primary failure. Proportions were compared between the radiocephalic and brachiocephalic groups using a chi-squared test. Outcomes of the AVFs that required intervention were described.
Results: Of 348 consecutive AVF creations, 257 (74%) and 91 (26%) were radiocephalic and brachiocephalic respectively. At six weeks, 76%, 14% and 10% of radiocephalic AVFs were functional, required intervention and had failed respectively. These compared with 70% (p=0.53), 21% (p=0.94) and 9% (p=0.68) for brachiocephalic AVFs. Of the radiocephalic AVFs that required intervention, 14% underwent surgical and 74% underwent radiological intervention with 60% deemed functional at follow-up. Of the brachiocephalic AVFs that required intervention, 32% underwent surgical and 69% underwent radiological intervention respectively, with 74% functional at follow-up.
Conclusions: Despite low primary failure rates, a high proportion of native AVFs require intervention to achieve maturation sufficient to facilitate haemodialysis.
Dr Janelle Prunster is a first year Nephrology Advanced Trainee at the Cairns and Hinterland Hospital Health Service in Queensland.