Abstract: FR-PO508
Informing Choices about Arteriovenous Fistula Creation: Insights from a Prospective Cohort Study
Session Information
- Dialysis Vascular Access
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Ghimire, Anukul, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Lloyd, Anita, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Szigety, Susan, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
- Merino, Jose Luis, Hospital Universitario del Henares, Coslada, Madrid, Spain
- Quinn, Robert R., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Tonelli, Marcello, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
Background
Selection of a dialysis access type should incorporate patients’ circumstances and preferences, termed the “Kidney Failure Life Plan”. Data on long-term outcomes for arteriovenous fistulas (AVF) can guide decisions surrounding the Plan. We did this study to inform patients’ choices about AVF creation, accounting for the risk of primary non-function and the presence of competing risks.
Methods
Prospective observational study of 257 adults with newly created AVF in Alberta, Canada. Participants were followed for 15 years or until the first outcome of death, outmigration, modality switch, or AVF failure/abandonment/ligation/removal. The primary outcome was primary function. Secondary outcomes included loss of primary patency and loss of secondary patency, assessed using Fine-Grey subdistribution hazard models to account for competing risks.
Results
Of 257 participants, 63.0% were male with mean age 62.3y, 54.9% had a radiocephalic AVF, and median follow up was 18.5 months. 50 AVF could not be assessed for primary function, with death being the most common reason. Of the remaining 207 AVF, 105 had primary function, and function was eventually established in 37/102 with primary non-function. In the 142 AVF with established function, loss of primary patency at 1, 3, and 5 years was 36.6%, 65.5% and 66.2% respectively. Similar values for loss of secondary patency were 0.7%, 11.3% and 16.2%. Overall, of 257 participants undergoing AVF creation, only 55% ultimately used that AVF for hemodialysis. These data were used to create the icon array (Figure) which is the basis for a decision aid.
Conclusion
This study highlights patient-important outcomes that may inform patients’ Kidney Failure Life Plans and choices about AVF creation. Future studies will validate and refine decision aids with input from patients.