SCM15: AVF and AVG: Maturation First
Dr. James Harms (JH), from the University of Alabama at Birmingham, Birmingham, Alabama, discusses his abstract for the National Kidney Foundation’s 2015 Spring Clinical Meetings (SCM15), Impact of Intervention to Promote Maturation on Survival of Arteriovenous Fistulas and Grafts, with Dr. Kenar Jhaveri, AJKD Blog Editor.
AJKDblog: Why don’t you tell us a little about your research and abstract being presented at the NKF 2015 Spring Meetings?
JH: Essentially we’d noted in the literature and at our institution that with increased arteriovenous fistula placements there has been a rise in fistulas that fail to mature without intervention. Previous studies have shown that fistulas that require intervention to achieve maturity have diminished survival and increased need for interventions to maintain patency. We hypothesized that fistulas that require intervention prior to successful use may lose some of their traditionally accepted benefits over arteriovenous grafts. We used our institutions vascular access database to analyze fistulas and grafts placed over a 6 year period, the frequency with which they required intervention to mature, the cumulative survival, and the necessity for intervention to maintain patency. Our study showed that fistulas required intervention prior to successful use far more frequently than grafts, and that requiring intervention to achieve maturity led to essentially equivalent survival with most arteriovenous grafts. We feel this is an important, novel finding in the field, and evidence that in certain circumstances, grafts should receive more consideration to be the first access placement.
AJKDblog: Does the choice of “graft” vs “fistula” change after your results on certain patient types?
JH: Our study showed that female patients as well as diabetics were more likely to have fistulas that failed to mature without intervention, these patient populations should garner more consideration for graft placement in some clinical scenarios. Ultimately the decision will continue to be made on a case by case basis, but I think our study gives clinicians more information to aid in decision making.
AJKDblog: Where do you and your group go from here?
JH: We will continue to study vascular access, and ways to improve access survival and decrease catheter dependence.
Click here for a full list of SCM15 abstracts of poster presentations.
Check out more AJKDblog coverage of the NKF’s 2015 Spring Clinical Meetings!
I question their chosen outcome. They looked at interventions for the access. Isn’t the reason we use fistulas is patient survival not access survival?