Background: Vascular access (VA) guidelines recommend the native arteriovenous fistula (AVF) as VA of first choice for chronic hemodialysis patients. AVF management is important in hemodialysis patient care. AVF survival is associated with various physical factors, but the effects of dialysis treatment factors upon AVF survival are still not clear. Methods: Study patients were treated at 498 dialysis facilities participating in the Dialysis Outcomes and Practice Patterns Study (DOPPS) 2 or 3 (2002-2007). Analyses included 1,183 incident hemodialysis patients (on dialysis ≤7 days and using an AVF at study entry) and 949 prevalent patients (on dialysis >7 days at DOPPS entry and using a new AVF created during study observation). AVF survival was modeled from the study entry date for incident patients and date of first AVF use for prevalent patients. Predictors of primary and final AVF survival were compared across Japan, North America and Europe/Australia/New Zealand (EUR/ANZ) with adjustments for patient characteristics. Results: No meaningful relationship was seen between AVF survival and various physician and staff practices. However, patients with prior catheter use displayed higher rates of primary and final AVF failure. Final AVF failure rates were higher in facilities with higher median blood flow rates (BFR). They were also greater in North America and EUR/ANZ than in Japan, but this difference was substantially attenuated after accounting for regional differences in facility median BFR. Conclusion: AVF longevity differed according to the DOPPS region, and was related to prior patient catheter use and facility BFR practice. Further longitudinal studies may help demonstrate meaningful associations between VA-handling skill and patency.

Keywords:
Arteriovenous fistula, Hemodialysis, Vascular access, Fistula patency
1.
Astor BC, Coresh J, Powe NR, Eustace JA, Klag MJ: Relation between gender and vascular access complications in hemodialysis patients. Am J Kidney Dis 2000;36:1126-1134.
2.
Saran R, Dystra DM, Wolfe RA, Gillespie B, Held PJ: Association between vascular access failure and the use of specific drugs: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis 2002;40:1255-1263.
3.
Hasegawa T, Elder SJ, Bragg-Gresham JL, Pisoni RL, Yamazaki S, Akizawa T, Jadoul M, Hugh RC, Port FK, Fukuhara S: Consistent aspirin use associated with improved arteriovenous fistula survival among incident hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Clin J Am Soc Nephrol 2008;3:1373-1378.
4.
Young EW, Goodkin DA, Mapes DL, Port FK, Keen ML, Chen K, Maroni BL, Wolfe RA, Held PJ: The Dialysis Outcomes and Practice Patterns Study (DOPPS): an international hemodialysis study. Kidney Int 2000;57(suppl 74):S74-S81.
5.
Pisoni RL, Gillespie BW, Dickinson DM, Chen K, Kutner M, Wolfe RA: The Dialysis Outcomes and Practice Patterns Study: design, data elements, and methodology. Am J Kidney Dis 2004;44(suppl 2):S7-S15.
6.
Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T, Akiba T, Canaud BJ, Pisoni RL: Vascular access use and outcomes: an international perspective from the Dialysis Outcomes and Practice Patterns Study. Nephrol Dial Transplant 2008;23:3219-3226.
7.
Rayner HC, Pisoni RL, Gillespie BW, Goodkin DA, Akiba T, Akizawa T, Saito A, Young EW, Port FK: Creation, cannulation and survival of arteriovenous fistulae: data from the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2003;63:323-330.
8.
Bonforte G, Zerbi S, Surian M: The middle-arm fistula: A new native arteriovenous vascular access for hemodialysis patients. Ann Vasc Surg 2004;18:448-452.
9.
Wong V, Ward R, Taylor J, Selvakumar S, How TV, Bakran A: Factors associated with early failure of arteriovenous fistulae for haemodialysis access. Eur J Vasc Endovasc Surg 1996;12:207-213.
10.
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.
11.
Quintalini G, Buoncristiani U, Fagugli R, Kuluiranu H, Ciao G, Rondini L, Lowenthal DT, Reboldi G: Survival of vascular access during daily and three times a week hemodialysis. Clin Nephrol 2000;53:372-377.
12.
Basile C, Ruggieri G, Vernaglione L, Montanaro A, Giordano R: The natural history of autogenous radio-cephalic wrist arteriovenous fistulas of haemodialysis patients: a prospective observational study. Nephrol Dial Transplant 2004;19:1231-1236.
13.
Ernandez T, Saudan P, Berney T, Merminod T, Bednarkiewicz M, Martin PY: Risk factors for early failure of native arteriovenous fistulas. Nephron Clin Pract 2005;101:c39-c44.
14.
Ohira S, Kon T, Imura T: Evaluation of primary failure in native AV-fistulae (early fistula failure). Hemodial Int 2006;10:173-179.
15.
Tessitore N, Bedogna V, Gammaro L, Lipari G, Poli A, Baggio E, Firpo M, Morana G, Mansueto G, Maschio G: Diagnostic accuracy of ultrasound dilution access blood flow measurement in detecting stenosis and predicting thrombosis in native forearm arteriovenous fistulae for hemodialysis. Am J Kidney Dis 2003;42:331-341.
16.
Woods JD, Turenne MN, Strawdeman RL, Young EW, Hirth RA, Port FK, Held PJ: Vascular access survival among incident hemodialysis patients in the United States. Am J Kidney Dis 1997;30:50-57.
17.
Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E, Gillespie B, Wolfe RA, Goodkin DA, Held PJ: Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int 2002;61:305-316.
18.
van Loon MM, Kessels AG, Van der Sande FM, Tordoir JH: Cannulation and vascular access-related complications in hemodialysis: factors determining successful cannulation. Hemodial Int 2009;13:498-504.
19.
Ravani P, Brunori G, Mandolfo S, Cancarini G, Imbasciati E, Marcelli D, Malberti F: Cardiovascular comorbidity and late referral impact arteriovenous fistula survival: a prospective multicenter study. J Am Soc Nephrol 2004;15:204-209.
20.
Portoles J, Lopez-Gomez JM, Gruss E, Aljama P, MAR Study Group: Course of vascular access and relationship with treatment of anemia. Clin J Am Soc Nephrol 2007;2:1163-1169.
21.
Besarab A, Bolton WK, Browne JK, Egrie JC, Nissenson AR, Okamoto DM, Schwab SJ, Goodkin DA: The effect of normal as compared with low hematocrit values in patients with cardiac disease who are receiving hemodialysis and epoetin. N Engl J Med 1998;339:584-590.
22.
Morena M, Bosc JY, Jaussent I, Dupuy AM, Terrier N, Leray-Moragues H, Flavier JL, Maurice F, Delcourt C, Cristol JP, Canaud B: The role of mineral metabolism and inflammation on dialysis vascular access failure. J Vasc Access 2006;7:77-82.
23.
Lin CH, Chua CH, Chiang SS, Liou JY, Hung HF, Chang CH: Correlation of intraoperative blood flow measurement with autogenous arteriovenous fistula outcome. J Vasc Surg 2008;48:167-172.
24.
McCarley P, Wingard RL, Shyr Y, Pettus W, Hakim RM, Ikizler TA: Vascular access blood flow monitoring reduces access morbidity and costs. Kidney Int 2001;60:1164-1172.
25.
Wootton DM, Ku DN: Fluid mechanics of vascular systems, diseases, and thrombosis. Annu Rev Biomed Eng 1999;1:299-329.
© 2013 S. Karger AG, Basel
2013
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