T SCOTT1, N GRAY1,2
1Sunshine Coast University Hospital, Birtinya, Queensland; 2The University of Queensland, Sunshine Coast Clinical School, Birtinya, Queensland
Aim: To retrospectively apply a validated predictive score, REDUCE FTM-1, to assess failure to mature (FTM) rates among new arteriovenous fistulas (AVFs) and compare the eGFR at referral for low and high risk AVFs.
Background: Commencing haemodialysis with a functional AVF as opposed to a dialysis catheter has been associated with reduced morbidity and mortality. The incident AVF rate in Australia remains poor. The CARI vascular access project showed a low eGFR at time of referral to vascular surgery. The REDUCE FTM-1 study reported FTM rates of 24%, 34%, 50% and 69% for low, moderate, high and very high risk AVFs respectively. Use of a FTM scoring system may identify those patients who need earlier referral for AVF creation.
Methods: All patients who had an AVF (n=126) created from 2011 to 2015 at one centre were included. The REDUCE FTM-1 clinical predictors of coronary artery disease, peripheral vascular disease, age > 65, and indigenous status were retrospectively applied to calculate a risk score. AVFs used within 6 months of creation (n=50) were included as per the REDUCE FTM-1 study.
Results: Most AVFs were low/moderate risk (66%) compared with high/very high risk (34%). The FTM rate among the low/moderate risk group was 15.2% and 35.3% in the high/very high risk group. The eGFR at referral to vascular surgery was 10ml/min/1.73m2 or greater for 48.5% of the low/moderate risk group compared with 58.8% for the high/very high risk group.
Conclusions: Retrospective application of REDUCE FTM-1 tool showed the FTM rate compared favourably with published literature. Patients at high risk of AVF FTM were not referred earlier than those at low risk, suggesting an opportunity for practice improvement.