Predictors of Arteriovenous Fistula Early Failure in End-Stage Renal Disease Patients: Real-World Data in Surabaya

Arteriovenous fistula (AVF) is the vascular access of choice in prevalent hemodialysis end-stage renal disease (ESRD) patients. However, there was a significant proportion of early AVF failure and its predictive factor was conflicting in several studies. We conducted a retrospective cohort study in 225 AVFs created in 159 patients. The purpose of this study was to identify the predictive factors of AVF early failure. The data variables included age at AVF creation, sex, history of diabetes, hypertension, cigarette smoking, AVF location and side, history of subclavian tunneled dialysis catheter and history of preoperative ultrasound mapping. This information was collected by interviewing the patient and by AVF scar inspection. AVF that was never coming into use was classified as an early failure. AVF creation in the wrist was significantly associated with a higher early failure rate (29.9%) compared with AVF creation at the elbow (4.4%) (p < 0.001). There was no significant association in terms of AVF early failure in terms of the other variables. We concluded that wrist AVF is significantly associated with early failure. However, this finding should not preclude the National Kidney Foundation's recommendation of using wrist AVF for the first choice of vascular access to conserve more proximal access sites for future use.