TITLE: A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis.

INTRODUCTION: Arteriovenous fistulas (AVF) are the preferred choice for vascular access in hemodialysis. We aim to identify factors that may contribute to AVF failure.

METHODS: Data regarding AVF survival were collected from 441 patients. All AVFs were either radial or brachial, of the end-to-side variety. Parameters studied were age, gender, diabetes mellitus, hypertension prior to end-stage kidney disease (ESKD), site of fistula, blood flow rate, venous pressure, dialysis vintage and frequency, needle gauge used during dialysis, year of fistula creation, and details of fistula failure.

FINDINGS: The 6-month, 1-year and 2-year AVF survival rates were 98.41%, 95.01%, and 89.57%. Failure rates were 17.2%, 5.5%, 26.8%, and 14.4% for dominant radial, non-dominant radial, dominant brachial and non-dominant brachial respectively (P < 0.001). Using a larger needle size had better AVF survival rate (P < 0.05). All other factors had no significant correlation with AVF failure.

CONCLUSION: There were no statistically significant differences in AVF patency with respect to gender, age, blood flow rate, presence of diabetes mellitus or systemic hypertension. A distally placed AVF in the nondominant arm had the best survival rate. Using a larger needle size, specifically 15G during dialysis, was associated with lowest AVF failure.

SOURCE: Jothi S, Kg H, Lesley N, et al. A multicentre analysis of the outcome of arteriovenous fistula in maintenance haemodialysis[J]. Semin Dial, 2020, 33(5):388-393. DOI: 10.1111/sdi.12907.

简介：动静脉内瘘（AVF）是血液透析中血管通路的首选。我们旨在确定可能导致AVF失败的因素。

方法：从441例患者中收集了有关AVF生存的数据。所有的AVF均为桡侧或肱侧，端侧吻合。研究的参数包括年龄，性别，糖尿病，终末期肾脏疾病（ESKD）之前的高血压，瘘管部位，血流速度，静脉压力，透析时间和频率，透析期间使用的针规，造瘘的年份以及瘘管破裂的详细信息。

结果：6个月，1年和2年AVF生存率分别为98.41％，95.01％和89.57％。优势手桡动脉，非优势手桡动脉，优势手肱动脉和非优势手肱动脉的失败率分别为17.2％，5.5％，26.8％和14.4％（P <0.001）。使用较大的针头具有更好的AVF生存率（P <0.05）。所有其他因素与AVF失败均无显着相关性。

结论：AVF通畅性在性别，年龄，血流量，糖尿病或系统性高血压方面无统计学差异。在非优势臂中放置在远端的AVF具有最佳的生存率。使用更大的针头直径，特别是在透析过程中使用15G针头，可使AVF失功率最低。

启发：更大的针头尽可使AVF失功率下降。