Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study

• Published in: Journal of the American Society of Nephrology Vol. 29; no. 11; pp. 2735 - 2744
• Main Authors: Robbin, Michelle L, Greene, Tom, Allon, Michael, Dember, Laura M, Imrey, Peter B, Cheung, Alfred K, Himmelfarb, Jonathan, Huber, Thomas S, Kaufman, James S, Radeva, Milena K, Roy-Chaudhury, Prabir, Shiu, Yan-Ting, Vazquez, Miguel A, Umphrey, Heidi R, Alexander, Lauren, Abts, Carl, Beck, Gerald J, Kusek, John W, Feldman, Harold I
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.11.2018
• Subjects: Adult; Aged; Algorithms; Arteriovenous Shunt, Surgical; Blood Flow Velocity; Brachial Artery - diagnostic imaging; Brachial Artery - physiology; Brachial Artery - surgery; Clinical Research; Cohort Studies; Female; Humans; Male; Middle Aged; Models, Cardiovascular; Postoperative Period; Predictive Value of Tests; Prognosis; Prospective Studies; Renal Dialysis - methods; Time Factors; Ultrasonography; Vascular Patency; clinical trial; hemodialysis; access blood flow; dialysis access; arteriovenous fistula; Ultrasonography
• ISSN: 1046-6673; 1533-3450
• DOI: 10.1681/ASN.2017111225

The utility of early postoperative ultrasound measurements in predicting arteriovenous fistula (AVF) clinical maturation is uncertain. We investigated the relationships of ultrasound parameters with AVF clinical maturation in newly created AVF, measured at 1 day and 2 and 6 weeks, in 602 participants of a multicenter, observational cohort study. A backward elimination algorithm identified ultrasound measurements that independently predicted unassisted and overall AVF maturation. Candidate variables included AVF blood flow, diameter, and depth, upper arm arterial diameter, presence of stenosis, presence of accessory veins, seven case-mix factors (age, sex, black race, AVF location, diabetes, dialysis status, and body mass index), and clinical center. We evaluated the accuracy of the resulting models for clinical prediction. At each ultrasound measurement time, AVF blood flow, diameter, and depth each predicted in a statistically significant manner both unassisted and overall clinical maturation. Moreover, neither the remaining ultrasound parameters nor case-mix factors were associated with clinical AVF maturation after accounting for blood flow, diameter, and depth, although maturation probabilities differed among clinical centers before and after accounting for these parameters. The crossvalidated area under the receiver operating characteristic curve for models constructed using these three ultrasound parameters was 0.69, 0.74, and 0.79 at 1 day and 2 and 6 weeks, respectively, for unassisted AVF clinical maturation and 0.69, 0.71, and 0.76, respectively, for overall AVF maturation. AVF blood flow, diameter, and depth moderately predicted unassisted and overall AVF clinical maturation. The other factors considered did not further improve AVF maturation prediction.