Survival of Primary Arteriovenous Fistula in 463 Patients on Chronic Hemodialysis

Aim: To assess the survival of the primary arteriovenous fistula created for dialysis in 463 chronic hemodialysis patients, because the main causes of morbidity among such patients are associated with vascular access-related complications.

Method: We analyzed 269 (58%) men and 194 (42%) women with median age of 58 years (range 12-83), who underwent 0-14,784 (median 1,584) hours of hemodialysis. Data analyzed were age, gender, body weight loss during hemodialysis session, smoking habits, cause of renal failure, diabetes, myocardial infarction, stroke, malignant neoplasm, arterial hypertension or hypotension, drugs (salicylates, dipyridamole, coumarin anticoagulants, heparin, oral antidiabetics, insulin), number of hemodialysis sessions and hours of hemodialysis per week, fistula location, platelet count, hematocrit, institution in which the fistula had been created, and dialysis center where the fistula had been used. Kaplan-Meier and univariate analysis (Mantel-Cox and generalized Wilcoxon test) with 0.05 statistical significance were used for data analysis, and the outcome of the fistula survival was determined with logistic regression.

Results: Out of 597 patients with primary arteriovenous fistula, 134 patients were lost to follow-up. In the remaining 463 patients the fistula survival was 73%, 63%, 52%, 44%, 36%, 10%, 3%, and <1% after 1, 2, 3, 4, 5, 10, 15, and 20 years, respectively. Factors affecting the survival of arteriovenous fistula were administration of heparin (p=0.004) and dipyridamole (p=0.012), hemodialysis-dependent hypotension (p=0.045), diabetes (p=0.009), presence of malignant neoplasm (p=0.003), institution in which the fistula had been created (p<0.001) or used (p=0.037), hours of hemodialysis per week (p=0.023), and number of hemodialysis sessions per week (p=0.007).

Conclusion: Primary arteriovenous fistula survival was shorter in end-stage renal disease patients with diabetes, hypotension, who underwent less than 3 hemodialysis sessions (<12 h) per week without heparin administration. Insufficient surgical experience, dipyridamole administration, and concomitant neoplasm contributed to arteriovenous fistula failure.