Predictors of Arteriovenous Fistula Failure: A post hoc Analysis of the FAVOURED Study

Omega 3 Fatty Acids (Fish Oils) and Aspirin in Vascular Access Outcomes in Renal Disease (FAVOURED) Study Collaborative Group, Yong Pey See, Yeoungjee Cho, Elaine M. Pascoe, Alan Cass, Ashley Irish, David Voss, Kevan R. Polkinghorne, Lai Seong Hooi, Loke-Meng Ong, Peta-Anne Paul-Brent, Peter G. Kerr, Trevor A. Mori, Carmel M. Hawley, David W. Johnson, Andrea K. Viecelli

Research output: Contribution to journalArticlepeer-review

Abstract

Background An autologous arteriovenous fistula (AVF) is the preferred hemodialysis vascular access, but successful creation is hampered by high rates of AVF failure. This study aimed to evaluate patient and surgical factors associated with AVF failure to improve vascular access selection and outcomes.

Methods This is a post hoc analysis of all participants of FAVOURED, a multicenter, double-blind, multinational, randomized, placebo-controlled trial evaluating the effect of fish oil and/or aspirin in preventing AVF failure in patients receiving hemodialysis. The primary outcome of AVF failure was a composite of fistula thrombosis and/or abandonment and/or cannulation failure at 12 months post-AVF creation, and secondary outcomes included individual outcome components. Patient data (demographics, comorbidities, medications, and laboratory data) and surgical factors (surgical expertise, anesthetic, intraoperative heparin use) were examined using multivariable logistic regression analyses to evaluate associations with AVF failure.

Results Of 536 participants, 253 patients (47%) experienced AVF failure during the study period. The mean age was 55±14.4 years, 64% were male, 45% were diabetic, and 4% had peripheral vascular disease. Factors associated with AVF failure included female sex (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.20 to 2.68), lower diastolic BP (OR for higher DBP, 0.85; 95% CI, 0.74 to 0.99), presence of central venous catheter (OR, 1.49; 95% CI, 1.02 to 2.20; P=0.04), and aspirin requirement (OR, 1.60; 95% CI, 1.00 to 2.56).

Conclusions
Female sex, requirement for aspirin therapy, requiring hemodialysis via a central venous catheter, and lower diastolic BP were factors associated with higher odds of AVF failure. These associations have potential implications for vascular access planning and warrant further studies.
Original languageEnglish
Pages (from-to)1259-1269
Number of pages11
JournalKidney360
Volume1
Issue number11
DOIs
Publication statusPublished - 25 Nov 2020

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