Factors associated with unsuccessful utilization and early failure of the arterio-venous fistula for hemodialysis.

BACKGROUND: Arteriovenous fistulae survive longer than grafts and catheters. However, their short term outcomes may not be as good. We sought to determine whether fistulae created in patients referred to a nephrologist less than 3 months before dialysis start show higher risk of unsuccessful use and early failure.
METHODS: All patients receiving a new vascular access over a six-year period at three centres were enrolled. Logistic and Cox's regression techniques were used to model late referral on successful utilization for <6 consecutive HD-sessions and time to failure within the first month from access creation, adjusting for demographics, comorbidities and surgical strategies.
RESULTS: Among the 535 subjects enrolled, 513 received a fistula. Without considering revisions, 119 fistulae (23.2%) were not successfully used and 61 (11.9%) failed early. Independent predictors of unsuccessful utilization were late referral (Odds Ratio 2.15 [95% Confidence Interval 1.23, 3.75]), vascular diseases (1.86 [1.16, 2.97]), absence of treated hypertension (2.07 [1.17, 3.68]), and heart failure limited to late referrals (10.74 [4, 28.82]). Late referral (Hazard Ratio 1.72 [1.05, 2.81]), absence of treated hypertension (1.80 [1.02, 3.18]) and heart failure (2.34 [1.34, 4.08]) also predicted primary early failure.
CONCLUSIONS: Late patient referral and presence of cardiovascular diseases, particularly heart failure, are potentially modifiable risk factors for short-term outcomes improvement of hemodialysis fistulae.