Arteriovenous fistulas (AVF) frequently fail to mature. Postoperative ultrasounds provide objective measurements to predict unassisted AVF use for hemodialysis (unassisted use) and guide interventions to salvage nonmaturing AVFs. The optimal ultrasound criteria to assess AVF maturation are uncertain. We analyzed data from a multicenter, randomized, controlled, clinical trial to compare 2 published ultrasound maturation criteria used to predict unassisted AVF use for hemodialysis.
We retrospectively analyzed prospective data on 105 patients undergoing new AVF creation, who underwent standardized postoperative ultrasounds at 6 and 12 weeks to measure AVF diameter and blood flow. Unassisted AVF use was defined as successful cannulation for ≥90 days without requiring prior surgical or percutaneous interventions. Two ultrasound criteria were assessed: (i) National Kidney Foundation (NKF) Kidney Disease Outcome Quality Initiative criteria: AVF outflow vein lumen diameter ≥6 mm and blood flow ≥600 mL/min; and (ii) University of Alabama at Birmingham (UAB) criteria: AVF outflow vein lumen diameter ≥4 mm and blood flow ≥500 mL/min. Performance characteristics were calculated for both criteria.
Compared to the NKF criteria, the UAB criteria had a higher sensitivity (89 vs.68%), but a lower specificity (42 vs. 70%) for unassisted AVF use. For radiocephalic AVFs, the UAB criteria had higher sensitivity (86 vs. 46%) and lower specificity (58 vs. 83%). For brachiocephalic AVFs, both UAB and NKF had high sensitivity (90 and 80%) but low specificity (21 and 53%), respectively.
Using the UAB ultrasound criteria would minimize unnecessary early interventions in AVFs likely to mature without an intervention, but would delay interventions in AVFs that are unlikely to mature. The UAB criteria may be preferred in patients receiving a radiocephalic AVF.
Post author correction
Article Type: ORIGINAL RESEARCH ARTICLE
AuthorsTimmy Lee, Missy Magill, Steven K. Burke, Andrew T. Blair, Michelle L. Robbin, Michael Allon
- • Accepted on 13/09/2017
- • Available online on 14/12/2017
This article is available as full text PDF.
- Lee, Timmy [PubMed] [Google Scholar] 1, 2, * Corresponding Author (firstname.lastname@example.org)
- Magill, Missy [PubMed] [Google Scholar] 3
- Burke, Steven K. [PubMed] [Google Scholar] 3
- Blair, Andrew T. [PubMed] [Google Scholar] 3
- Robbin, Michelle L. [PubMed] [Google Scholar] 4
- Allon, Michael [PubMed] [Google Scholar] 1
Department of Medicine and Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama - USA
Veterans Affairs Medical Service, Birmingham, Alabama - USA
Research and Development, Proteon Therapeutics, Waltham, Massachusetts - USA
Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama - USA