The influence of maturation period of arteriovenous fistula on its survival in patients undergoing maintenance hemodialysis

Park, Kyu Yong; Cho, Jin Won; Yeo, Mi Ae; Yang, Hyung Won; Kim, Kyung Hee; Lee, Ki Sung; Koo, Ja Ryong; Kim, Guen Ho; Chun, Rho Won; Kim, Hyung Jik; Chae, Dong Wan; Noh, Jung Woo

Abstract

BACKGROUND: Arteriovenous fistula(AVF) has been the most important, primary mode of achieving vascular access for chronic hemodialysis by this time. In general, maturation period over 4 to 8 weeks after operation for the formation of AVF has been recommended for the long-term survival of AVF, and so insertion of central venous catheter without using AVF being matured has been primarily recommended whenever hemodialysis is needed. But not infrequently, serious complications have been reported in association with the insertion and the use of central venous catheter. So earlier use of AVF is regarded as a good method of avoiding serious complications with regard to the insertion and the use of central venous catheter. But early use of AVF has not been generally recommended, for early use of AVF has been regarded to be associated with early failure of AVF. But few studies have reported the correlation between maturation period and AVF survival. And in practice, early use of AVF has already been performed frequently by not a few nephrologists or nurses of dialysis units. So authors tried to examine the correlation between maturation period and AVF survival rate, and to find the validity of early use of AVF if it is regarded usable for the hemodialysis by experienced hemodialysis nurses and nephrologists.
METHODS
A retrospective analysis using 88 AVF cases which had been created in 85 patients from Oct. 1986 through June 1996, and from which authors could get enough information for this study was done. Authors compared one year survival rates of AVF according to the maturation period, the presence of DM, and condition of AVF assessed clinically by doctors and experienced nurses in hemodialysis units. Also from the cases with AVF obstruction, authors examined the 1st, 2nd, and 3rd year survival rate of AVF according to the maturation period.
RESULTS
One year survival rate of AVF with maturation period less than 4 weeks was higher than that with maturation period more than 4 weeks, but there was no statistical significance. One year survival rate, irrespective of the length of maturation period for AVFs, of AVF regarded to be usable and good for hemodialysis was higher than that of AVF regarded to be usable but not good for hemodialysis. In the study with the AVF obstruction group only, one year survival rate of AVF with maturation period less than 4 weeks was higher than that of AVF with maturation period more than 4 weeks but there was no statistical significance. And one year AVF survival rate was higher in non DM group(94.1%) than DM group(60%) regardless of maturation period of AVF(p<0.05).
CONCLUSION
On the contrary to the views that longer maturation period of more than 4 weeks will be necessary for the long-term survival of AVF, our results suggest that shorter maturation period for AVF less than 4 weeks does not necessarily mean early failure of AVF once AVF is regarded to be usable for hemodialysis. So it is suggested that early use of AVF instead of inserting central venous catheter is a reasonable approach for getting an adequate vascular access for hemodialysis in chronic renal failure patients who were subjected to receive hemodialysis on waiting peroid of AVF maturation.