Outcome of a comprehensive follow-up program to enhance maturation of autogenous arteriovenous hemodialysis access

ObjectiveTo examine the outcome of a comprehensive follow-up program for autogenous arteriovenous hemodialysis access (AVF) when performed by the hemodialysis access surgeon.MethodsPatients with first time AVFs between 2000 and 2005 underwent history and physical examination between the third and sixth postoperative weeks, followed by repeat examination every 6 to 8 weeks until maturation. Primary outcomes included maturation assessment and interventions required prior to maturation. Maturation was defined as 4 consecutive weeks of sustainable AVF hemodialysis access.ResultsOne hundred thirteen patients had 113 AVFs. Mean age was 64 years (range: 26-94) and 52% were male. AVFs included 8 (7%) radiocephalic, 90 (80%) brachiocephalic, and 15 (13%) basilic vein transposition. Overall, the maturation rate was 72% (failure rate of 28%). Excluding deaths and transplants prior to maturation, the maturation rate was 82% (failure rate 18%). Eighty-three (73%) patients had no intervention prior to maturation and 30 (27%) required intervention. There was no significant difference in failure rate between AVFs not requiring an intervention (13 of 83, 15%) and those requiring intervention (5 of 30, 16%). For AVFs requiring intervention, 23 (61%) patients had an endovascular intervention and 15 (39%) an operative intervention. One intervention was performed in 64%, two in 24%, and three in 12%. Ninety-three percent of AVFs having an endovascular intervention matured compared with 60% having operative intervention (P = .10). AVFs requiring intervention had a maturation time (mean: 35 weeks, range: 10-54) that was significantly longer (P = .003) than those without (mean 11 weeks, range: 6-35).ConclusionsWith a surgeon directed comprehensive follow-up program to assess AVF maturation, a large proportion (30 of 43, 69%) of AVFs with a problem were detected. Of those identified, most (25 of 30, 83%) could be salvaged to maturation with intervention. The Kidney and Dialysis Outcome Quality Initiative (K/DOQI) should consider incorporating a comprehensive follow-up program into its guidelines.