First Cannulation Should Be More Than 3 Weeks after Creation of a Radial-Cephalic Arterio-Venous Fistula

Keisuke Ota, Michio Fukuda, Tamaki Wakamatsu-Yamanaka, Toshiyuki Miura, Masashi Mizuno, Ryo Sato, Daisuke Fuwa, Nobuo Kato, Minamo Ono, Taisei Suzuki, Naoyuki Fukuda, Yumiko Nishimoto, Toshihito Haba, Masaki Kobayashi, Osamu Ishida, Yoshihiro Ota, Satoshi Sugiyama, Kunio Morozumi and Nobuyuki Ohte

Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, Japan
Department of Oral Surgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
Chukyo-kosei Clinic, Japan
Department of Transplant and Endocrine Surgery, Nagoya Second Red Cross Hospital, Nagoya, Japan
Department of Laboratory of Molecular Pathology and Metabolic Disease, Tokyo University of Science, Japan
Department of Cardiovascular Surgery, National Defense Medical College, Japan
Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Japan
Kanayama Clinic, Nagoya, Japan
Masuko Memorial Hospital, Japan

^*Correspondance to: Michio Fukuda 

 PDF  Full Text DOI: 10.25107/2474-1647.2299

Abstract

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.

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Cite the article

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.