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Comorbidities Do not Influence Primary Fistula Success in Incident Hemodialysis Patients: A Prospective Study

Wenjie Wang^*, Brendan Murphy^*, Serdar Yilmaz, Marcello Tonelli^,, Jennifer MacRae^*, and Braden J. Manns^*,,||

^* Division of Nephrology, Department of Medicine, Division of Transplantation, Department of Surgery, and ^|| Department of Community Health Sciences, University of Calgary, Foothills Medical Center, Calgary, and Division of Nephrology, Department of Medicine, University of Alberta, and Institute of Health Economics, Edmonton, Alberta, Canada

Correspondence: Dr. Braden J. Manns, Foothills Medical Center, 1403 29th Street NW, Calgary, Alberta, Canada, T2N 2T9. Phone: 403-944-2595; Fax: 403-944-2876; E-mail: Braden.Manns{at}CalgaryHealthRegion.ca

Background and objectives: Concern about primary fistula failure may contribute to the underuse of arteriovenous fistula. The objective of this study was to investigate the baseline clinical parameters associated with primary fistula success.

Design, setting, participants, & measurements: Consecutive incident patients who commenced dialysis during a 28-mo period in a regional renal program were studied. Data on patient-related variables and on surgical approach (e.g., whether the surgeons routinely assess vessel size during the operation) were collected. Primary fistula success was defined as an arteriovenous fistula that was able to afford successful dialysis for 3 h with blood pump speed of 300 ml/min for three consecutive sessions.

Results: A total of 205 (69%) patients had an AVF attempted as their first vascular access. The overall primary success rate was 64% and was similar for radiocephalic and brachiocephalic fistula. Logistic regression was done separately for patients with the two types of fistula because of the presence of statistical interaction. For radiocephalic fistula, male gender was the only parameter associated with primary fistula success (odds ratio 3.57; P = 0.01). The presence of comorbidity was not significantly associated with primary fistula failure.

Conclusions: Despite significant patient comorbidity, there was a high primary fistula success rate among this incident hemodialysis cohort. Given that vessel size may be the ultimate determinant of fistula success, if surgeons assess vessel size perioperatively, then the presence of significant comorbidity might not preclude arteriovenous fistula from being attempted as the initial access.