Background: Most guidelines recommend the creation of arteriovenous fistula (AVF) in patients with chronic kidney disease (CKD) stage 4. However, an increasing number of studies suggest that early AVF creation leads to high rates of AVF failure and death before dialysis commencement. Only the Japanese guideline recommends AVF creation at CKD stage 5; however, no data are available regarding access-related outcomes at this stage. Method: This was a multicenter cohort study involving Japanese CKD stage 5 patients who underwent preemptive AVF creation from 2009 to 2013. The primary outcome was unnecessary AVF creation, defined as death before requiring dialysis or AVF failure before dialysis commencement. The secondary outcome was dialysis commencement. The associations with candidate predictors and the outcomes were examined. Results: A total of 303 patients were registered. Four cases of death before dialysis and 13 cases of AVF failure before dialysis commencement were observed. A total of 283 patients who advanced to dialysis were found to have functional AVFs. The cumulative incidences of unnecessary AVF creation and dialysis commencement at 1 year were 4.8 and 89.3%, respectively. Competing risk regression analyses showed that age ≥75 years (subhazard ratio [SHR] 3.12, 95% CI 1.20-8.09) and female gender (SHR 3.31, 95% CI 1.20-9.09) were associated with unnecessary AVF creation. Conclusions: A low incidence of unnecessary AVF creation was revealed among Japanese patients who received AVF at CKD stage 5. These results may help clarify the natural history of unnecessary AVF creation for other countries reformatting their guidelines regarding late vascular access creation.

Keywords:
Vascular access, Hemodialysis, Arteriovenous fistula, Unnecessary arteriovenous fistula, Dialysis commencement
1.
Di Iorio BR, Bellizzi V, Cillo N, Cirillo M, Avella F, Andreucci VE, De Santo NG: Vascular access for hemodialysis: the impact on morbidity and mortality. J Nephrol 2004;17:19-25.
2.
Pisoni RL, Arrington CJ, Albert JM, Ethier J, Kimata N, Krishnan M, Rayner HC, Saito A, Sands JJ, Saran R, Gillespie B, Wolfe RA, Port FK: Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis 2009;53:475-491.
3.
Vascular Access Work Group: Clinical practice guidelines for vascular access. Am J Kidney Dis 2006;48(suppl 1):S248-S273.
4.
Jindal K, Chan CT, Deziel C, Hirsch D, Soroka SD, Tonelli M, Culleton BF: Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology. J Am Soc Nephrol 2006;17(3 suppl 1):S1-S27.
5.
Tordoir J, Canaud B, Haage P, Konner K, Basci A, Fouque D, Kooman J, Martin-Malo A, Pedrini L, Pizzarelli F, Tattersall J, Vennegoor M, Wanner C, ter Wee P, Vanholder R: EBPG on vascular access. Nephrol Dial Transplant 2007;22(suppl 2):ii88-ii117.
6.
Kukita K, Ohira S, Amano I, Naito H, Azuma N, Ikeda K, Kanno Y, Satou T, Sakai S, Sugimoto T, Takemoto Y, Haruguchi H, Minakuchi J, Miyata A, Murotani N, Hirakata H, Tomo T, Akizawa T: 2011 update Japanese society for dialysis therapy guidelines of vascular access construction and repair for chronic hemodialysis. Ther Apher Dial 2015;19(suppl 1):1-39.
7.
Oliver MJ, Rothwell DM, Fung K, Hux JE, Lok CE: Late creation of vascular access for hemodialysis and increased risk of sepsis. J Am Soc Nephrol 2004;15:1936-1942.
8.
Weber CL, Djurdjev O, Levin A, Kiaii M: Outcomes of vascular access creation prior to dialysis: building the case for early referral. ASAIO J 2009;55:355-360.
9.
Kimball TA, Barz K, Dimond KR, Edwards JM, Nehler MR: Efficiency of the kidney disease outcomes quality initiative guidelines for preemptive vascular access in an academic setting. J Vasc Surg 2011;54:760-765; discussion 765-766.
10.
Oliver MJ, Quinn RR, Garg AX, Kim SJ, Wald R, Paterson JM: Likelihood of starting dialysis after incident fistula creation. Clin J Am Soc Nephrol 2012;7:466-471.
11.
Hod T, Desilva RN, Patibandla BK, Vin Y, Brown RS, Goldfarb-Rumyantzev AS: Factors predicting failure of AV “fistula first” policy in the elderly. Hemodial Int 2014;18:507-515.
12.
Lee T, Thamer M, Zhang Y, Zhang Q, Allon M: Outcomes of elderly patients after predialysis vascular access creation. J Am Soc Nephrol 2015;26:3133-3140.
13.
Jadlowiec CC, Mannion EM, Lavallee M, Brown MG: Hemodialysis access in the elderly: outcomes among patients older than seventy. Ann Vasc Surg 2016;31:77-84.
14.
Shechter SM, Skandari MR, Zalunardo N: Timing of arteriovenous fistula creation in patients with CKD: a decision analysis. Am J Kidney Dis 2014;63:95-103.
15.
Hiremath S, Knoll G, Weinstein MC: Should the arteriovenous fistula be created before starting dialysis?: a decision analytic approach. PLoS One 2011;6:e28453.
16.
Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A: Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis 2009;53:982-992.
17.
Gooley TA, Leisenring W, Crowley J, Storer BE: Estimation of failure probabilities in the presence of competing risks: new representations of old estimators. Stat Med 1999;18:695-706.
18.
Satagopan JM, Ben-Porat L, Berwick M, Robson M, Kutler D, Auerbach AD: A note on competing risks in survival data analysis. Br J Cancer 2004;91:1229-1235.
19.
Hanafusa N, Nomura T, Hasegawa T, Nangaku M: Age and anemia management: relationship of hemoglobin levels with mortality might differ between elderly and nonelderly hemodialysis patients. Nephrol Dial Transplant 2014;29:2316-2326.
20.
Nakai S, Iseki K, Itami N, Ogata S, Kazama JJ, Kimata N, Shigematsu T, Shinoda T, Shoji T, Suzuki K, Taniguchi M, Tsuchida K, Nakamoto H, Nishi H, Hashimoto S, Hasegawa T, Hanafusa N, Hamano T, Fujii N, Masakane I, Marubayashi S, Morita O, Yamagata K, Wakai K, Wada A, Watanabe Y, Tsubakihara Y: An overview of regular dialysis treatment in Japan (as of 31 December 2010). Ther Apher Dial 2012;16:483-521.
21.
Fine JP, Gray RJ: A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999;94:496-509.
22.
Saran R, Dykstra DM, Pisoni RL, Akiba T, Akizawa T, Canaud B, Chen K, Piera L, Saito A, Young EW: Timing of first cannulation and vascular access failure in haemodialysis: an analysis of practice patterns at dialysis facilities in the DOPPS. Nephrol Dial Transplant 2004;19:2334-2340.
23.
Berry SD, Ngo L, Samelson EJ, Kiel DP: Competing risk of death: an important consideration in studies of older adults. J Am Geriatr Soc 2010;58:783-787.
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2017
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