Keisuke Ota1, Michio Fukuda1*, Tamaki Wakamatsu-Yamanaka1, Toshiyuki Miura1, Masashi Mizuno1, Ryo Sato1, Daisuke Fuwa1, Nobuo Kato1,6, Minamo Ono1, Taisei Suzuki1, Naoyuki Fukuda2, Yumiko Nishimoto3, Toshihito Haba4, Masaki Kobayashi1,5, Osamu Ishida6, Yoshihiro Ota7, Satoshi Sugiyama8, Kunio Morozumi1,9 and Nobuyuki Ohte1
1Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
2Department of Oral Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
3Chukyo-kosei Clinic, Japan
4Department of Transplant and Endocrine Surgery, Nagoya Second Red Cross Hospital, Nagoya, Japan
5Department of Laboratory of Molecular Pathology and Metabolic Disease, Tokyo University of Science, Japan
6Department of Cardiovascular Surgery, National Defense Medical College, Japan
7Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Japan
8Kanayama Clinic, Nagoya, Japan
9Masuko Memorial Hospital, Japan
Background: The KDOQI (Kidney Disease Outcomes Quality Initiative) recommends not using Arterio-Venous-Fistulas (AVFs) for Hemodialysis treatment (HD) within 1-month after creation because earlier cannulation (≤ 14 days) leads to reduced fistula survival.Methods: This retrospective cohort study was conducted in 205 patients, who started maintenance HD with a Radial-Cephalic-AVF (RC-AVF) based on institutional guidelines similar to the KDOQI recommendations. Configuration of the RC-AVF was standardized. Postoperative day from creation to first RC-AVF cannulation was abbreviated as POD. The primary endpoint was the first occurrence of a Vascular Access (VA) event (thrombectomy, surgical revision, or percutaneous transluminal angioplasty). Hazard ratios and 95% confidence intervals for the primary endpoint were determined. The cut-off POD for a VA event was calculated using the Receiver-Operating Characteristic curve and a Diagnostic Performance plot.Results: The primary endpoint occurred in 85 patients (41%) during 52 months (median). The cutoff POD to predict a VA event was <22 days. Cumulative incidence rates of VA endpoints were 53% and 31% for PODs ≤ 21 and >21 days, respectively (p=0.0008). A POD ≥ 22 days reduced the risk of a VA event by 52% compared with a POD <22 days. No significant difference in a VA event was seen for a POD ≤ 14 and a POD 15-21 days. A POD ≥ 22 days exerted a 60% reduction in a VA event compared with a POD ≤ 14 days.Discussion: The time from creation until the first cannulation of a RC-AVF should be set at more than 3 weeks. This finding provides a good example of the KDOQI recommendations.
Ota K, Fukuda M, Wakamatsu-Yamanaka T, Miura T, Mizuno M, Sato R, et al. First Cannulation Should Be More Than 3 Weeks after Creation of a Radial-Cephalic Arterio-Venous Fistula. Clin Surg. 2019; 4: 2299.