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Comparison of postoperative ultrasound criteria to predict unassisted use of arteriovenous fistulas for hemodialysis

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusions

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

DOI:10.5301/jva.5000818

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Authors

Timmy Lee, Missy Magill, Steven K. Burke, Andrew T. Blair, Michelle L. Robbin, Michael Allon

Article History

Disclosures

Financial support: Dr. Lee is supported by grant 2R44 DK109789-02 from the National Institutes of Diabetes, Digestive and Kidney Diseases (NIDDK), and grant 1I01BX003387-01A1 from a Veterans Affairs Merit Award. Dr. Allon is supported by grant 1R21DK104248-01A1 from the National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK).
Conflict of interest: Dr. Lee is a consultant for Proteon Therapeutics, Merck, and Boston Scientific. Dr. Allon is also a consultant for CorMedix.
Meeting presentation: Portions of this manuscript were presented in abstract form at the American Society of Nephrology Kidney Week, November 17, 2016, at Chicago, Illinois, USA.

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Authors

Affiliations

  • 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

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