Ultrasound was useful to assess the likelihood of arteriovenous fistula maturation, with arteriovenous fistula blood flow, diameter and depth as “moderate” predictors of unassisted and overall arteriovenous fistula clinical maturation in older patients with chronic kidney disease, according to a recently published study.
Michelle L. Robbin
“If there is a clinical concern about [arteriovenous fistula] AVF maturation after surgery, a 6-week ultrasound can help the clinician assess the likelihood of AVF maturation,” study author Michelle L. Robbin, MD, MS, FACR, FSRU, FAIUM, told Healio.com/Nephrology. “If the AVF does not appear ready for dialysis access, management decisions such as the need for AVF intervention or watchful waiting for expected maturation can be aided based on 6-week ultrasound measurements of AVF depth, diameter and blood flow.”
In the Hemodialysis Fistula Maturation Study, 602 patients with CKD who underwent creation of a new single-stage upper extremity AVF were identified. Robbin and colleagues performed ultrasound standardized mapping before surgery and ultrasound AVF evaluation at 1 day, 2 weeks and 6 weeks postoperatively. Investigators also identified ultrasound measurements that independently predicted unassisted AVF and overall AVF maturation with a backward selection algorithm. Among the candidate variables were AVF blood flow, AVF diameter and depth, upper arm arterial diameter, stenosis presence, presence of accessory veins, seven case-mix factors and clinical center. Accuracy of the resulting models was assessed for clinical prediction.
Results showed AVF blood flow, diameter and depth predicted in a statistically significant manner the unassisted and overall clinical maturation at each ultrasound measurement timepoint. Investigators noted both ultrasound parameters and case-mix factors were not correlated with AVF maturation after they accounted for blood, diameter and depth. However, the maturation probabilities were different among the clinical centers before and after they accounted for these parameters. At day 1, 2 weeks and 6 weeks, the cross-validated area under receiver operative characteristic curve for the developed models based on the ultrasound parameters was 0.69, 0.74 and 0.79, respectively, for unassisted AVF. For overall AVF maturation, this was 0.69, 0.71 and 0.76, respectively. – by Monica Jaramillo
Disclosures: Robbin reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.