MO780SURVIVAL STUDY OF ARTERIOVENOUS FISTULAS CREATED IN A HIGH RESOLUTION HOSPITAL

• Published in: Nephrology, dialysis, transplantation Vol. 36; no. Supplement_1
• Main Authors: Piccone Saponara, Luis Guillermo, Castro Fernández, Maria Paz, Uribe Heredia, Nancy Giovanna, Carreño Parrilla, Agustín, Anaya Fernandez, Sara, Ferrer García, Guillermo, García Conejo, Gloria, Ugarte Cámara, Marina, Valle Dominguez, Casimiro, Romero Barragán, Maria del Pilar, Vozmediano Poyatos, Maria del Carmen
• Format: Journal Article
• Language: English
• Published: 29.05.2021
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfab103.0018

Abstract Background and Aims Clinical practice guidelines recommend an arteriovenous fistula (AVF) as the ideal vascular access for hemodialysis. Autologous AVFs have higher primary, assisted primary and overall survival, associated with lower morbidity and mortality compared to prosthetic AVFs. However, primary failure of AVFs function is not uncommon, above all due to the vascular pathology of patients on hemodialysis (HD). We determined the survival rates in a series of vascular accesses created in a high-resolution hospital. Method Cross-sectional study; We include all AVFs performed during the last 20 years. Demographic variables (age, sex), etiology of CKD and associated comorbidity were collected. We determine the primary, assisted and global survival times. Statistical analysis with SPSS 25.0. Categorical variables are expressed as percentages and are compared using the Chi2 test. Quantitative variables are expressed as mean ± standard deviation and the Mann Whitney Student-T/U was used to compare them. We performed a kaplan-Meier analysis determining primary, assisted and overall survival. Statistical significance for a value of p <0.05. Results 622 AVFs performed in 482 patients were reviewed. 86.8% were autologous. The mean age was 65.4±14 years; 66.6% were male. The most frequent etiologies of CKD were diabetic nephropathy (30.2%), unknown (18%), and glomerulonephritis (16.6%). 91.2% had arterial hypertension (HBP) and diabetes mellitus (DM) 47.9%. 48.7% received antiplatelet therapy and 15.6% anticoagulation prior to the creation of the AVF. 27% presented primary failure. In the survival analysis using the Kaplan Meier test, the mean time to perform angioplasty in dysfunctional AVFs was 14.6±1.37 months and to perform a thrombectomy 17.6±1.31 months. The overall survival of AVFs was 41.9±2 months. When assessing the type of AVF, we observed a longer survival for autologous (31.5±1.8) vs prosthetic (21.8±3.6) (p = 0.03 log Rank 4.73). Conclusion In our study, autologous AVFs have better survival compared to prosthetic ones. Of the AVFs created, primary survival at one year (requiring angioplasty) was 64%, assisted primary survival (requiring thrombectomy) was 42%, and overall survival 24%.