An association has been found between early follow-up evaluation in the wake of arteriovenous fistula (AVF) creation procedures and reduced time to successful cannulation for dialysis by the authors of a report in the Annals of Vascular Surgery.
First author Mariah Buzzell and corresponding author Yana Etkin (both Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA) et al carried out a retrospective analysis of patients at a single centre to examine the effects of follow-up timing on cannulation outcomes. With reference to studies including Jehad Almasri (Mayo Clinic, Rochester, USA) et al’s in the Journal of Vascular Surgery in 2016, they state that AVF maturation takes 3–4 months with a 25–50% rate of secondary maturation and 20–60% overall failure rate. They note also that the Kidney Disease Outcomes Quality Initiative (KDOQI) guideline recommends a follow-up evaluation at 4–6 weeks for those who receive an AVF. “This recommendation,” they emphasise however, “is based only on expert opinion and [is] ‘ungraded’ due to lack of strong evidence, as few studies have assessed the follow-up schedule.”
Seeking to contribute to the body of evidence, they devised their single-centre retrospective analysis to include 517 patients with AVFs created by one board-certified surgeon between 2017 and 2021. In total, after loss to follow-up, the data from 400 patients were used, with 289 in an early follow-up group, where the median time to follow-up was 39 days, and 111 in a delayed follow-up group, where the median time was 78 days.
The authors found a maturation rate of 81% in the early group and 87% in the delayed group (p=0.1), and both groups experienced similar rates of reintervention for maturation assistance (57% versus 66%; p=0.2). Regarding time to first cannulation, however, there was significant difference. The early group had a “significantly shorter median time to cannulation” of 50 days compared with the delayed group’s 88 (p<0.0001). The patients in this group also experienced a shorter median time to catheter-free haemodialysis of 75 days to 118 (p<0.0001). Four months after their AVF creation procedures, 74% of those in the early follow-up group had successfully undergone cannulation compared to 63% in the delayed follow-up group (p=0.0001). At the same point, the incidence of catheter-free dialysis was 65% in the early follow-up group and 50% in the delayed follow-up group (p=0.036).
Reviewing their findings, the study authors cite advantages of successful AVFs compared with central venous catheters (CVCs), among them better long-term patency and lower infection rates. AVFs’ long maturation periods, cited as a drawback, may be mitigated, Buzzell et al suggest, by earlier follow-up. “Instituting a standardised post-operative follow-up schedule after AVF creation could be a low-cost intervention for improving access-related outcomes,” they propose, adding finally that it may also succeed in cutting the time spent by patients using CVCs.