Background: Kidney failure is associated with a high burden of morbidity and mortality. Previous studies have raised the possibility that arteriovenous fistula (AVF) creation may attenuate eGFR decline. This study aimed to compare eGFR decline in predialysis patients with an AVF, matched to patients oriented toward peritoneal dialysis (PD). Methods: Predialysis patients with an AVF and those oriented toward PD were retrospectively matched using a propensity score. Time zero was defined as the "AVF creation date" for the AVF group and the "date when eGFR was closest to the matched patient's eGFR at AVF creation" for the PD group. Crude and predicted eGFR decline in AVF and PD groups were compared before and after time zero using mixed-effect linear regressions. Results: In total, 61 pairs were matched. Crude annual eGFR decline before AVF creation/time zero was -4.1 ml/min per m2 per year in the AVF group versus -5.3 ml/min per m2 per year in the PD group (P=0.75) and after time zero, -2.5 ml/min per m2 per year in the AVF group versus -4.5 ml/min per m2 per year in the PD group (P=0.02). The predicted annual decline decreased from -5.1 ml/min per m2 per year in the AVF group before AVF creation to -2.8 ml/min per m2 per year after (P<0.01), whereas there was no difference in the PD group (-5.5 versus -5.1 ml/min per m2 per year respectively, P=0.41). Conclusions: In this matched study, AVF creation was associated with a deceleration of kidney function decline compared with a control PD-oriented group. Prospective studies are needed to assess the potential mechanisms between vascular access creation and eGFR slope attenuation.
Background: Kidney failure is associated with a high burden of morbidity and mortality. Previous studies have raised the possibility that arteriovenous fistula (AVF) creation may attenuate eGFR decline. This study aimed to compare eGFR decline in predialysis patients with an AVF, matched to patients oriented toward peritoneal dialysis (PD). Methods: Predialysis patients with an AVF and those oriented toward PD were retrospectively matched using a propensity score. Time zero was defined as the "AVF creation date" for the AVF group and the "date when eGFR was closest to the matched patient's eGFR at AVF creation" for the PD group. Crude and predicted eGFR decline in AVF and PD groups were compared before and after time zero using mixed-effect linear regressions. Results: In total, 61 pairs were matched. Crude annual eGFR decline before AVF creation/time zero was -4.1 ml/min per m2 per year in the AVF group versus -5.3 ml/min per m2 per year in the PD group (P=0.75) and after time zero, -2.5 ml/min per m2 per year in the AVF group versus -4.5 ml/min per m2 per year in the PD group (P=0.02). The predicted annual decline decreased from -5.1 ml/min per m2 per year in the AVF group before AVF creation to -2.8 ml/min per m2 per year after (P<0.01), whereas there was no difference in the PD group (-5.5 versus -5.1 ml/min per m2 per year respectively, P=0.41). Conclusions: In this matched study, AVF creation was associated with a deceleration of kidney function decline compared with a control PD-oriented group. Prospective studies are needed to assess the potential mechanisms between vascular access creation and eGFR slope attenuation.
Authors: Charmaine E Lok; Thomas S Huber; Timmy Lee; Surendra Shenoy; Alexander S Yevzlin; Kenneth Abreo; Michael Allon; Arif Asif; Brad C Astor; Marc H Glickman; Janet Graham; Louise M Moist; Dheeraj K Rajan; Cynthia Roberts; Tushar J Vachharajani; Rudolph P Valentini Journal: Am J Kidney Dis Date: 2020-03-12 Impact factor: 8.860
Authors: Rajiv Saran; Bruce Robinson; Kevin C Abbott; Lawrence Y C Agodoa; Patrick Albertus; John Ayanian; Rajesh Balkrishnan; Jennifer Bragg-Gresham; Jie Cao; Joline L T Chen; Elizabeth Cope; Sai Dharmarajan; Xue Dietrich; Ashley Eckard; Paul W Eggers; Charles Gaber; Daniel Gillen; Debbie Gipson; Haoyu Gu; Susan M Hailpern; Yoshio N Hall; Yun Han; Kevin He; Paul Hebert; Margaret Helmuth; William Herman; Michael Heung; David Hutton; Steven J Jacobsen; Nan Ji; Yan Jin; Kamyar Kalantar-Zadeh; Alissa Kapke; Ronit Katz; Csaba P Kovesdy; Vivian Kurtz; Danielle Lavalee; Yi Li; Yee Lu; Keith McCullough; Miklos Z Molnar; Maria Montez-Rath; Hal Morgenstern; Qiao Mu; Purna Mukhopadhyay; Brahmajee Nallamothu; Danh V Nguyen; Keith C Norris; Ann M O'Hare; Yoshitsugu Obi; Jeffrey Pearson; Ronald Pisoni; Brett Plattner; Friedrich K Port; Praveen Potukuchi; Panduranga Rao; Kaitlyn Ratkowiak; Vanessa Ravel; Debabrata Ray; Connie M Rhee; Douglas E Schaubel; David T Selewski; Sally Shaw; Jiaxiao Shi; Monica Shieu; John J Sim; Peter Song; Melissa Soohoo; Diane Steffick; Elani Streja; Manjula Kurella Tamura; Francesca Tentori; Anca Tilea; Lan Tong; Megan Turf; Dongyu Wang; Mia Wang; Kenneth Woodside; April Wyncott; Xin Xin; Wei Zang; Lindsay Zepel; Sai Zhang; Hui Zho; Richard A Hirth; Vahakn Shahinian Journal: Am J Kidney Dis Date: 2017-03 Impact factor: 8.860
Authors: D Hernández; F Díaz; M Rufino; V Lorenzo; T Pérez; A Rodríguez; E De Bonis; M Losada; J M González-Posada; A Torres Journal: J Am Soc Nephrol Date: 1998-08 Impact factor: 10.121
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391