Objectives and design of the hemodialysis fistula maturation study

Laura M. Dember, Peter B. Imrey, Gerald J. Beck, Alfred K. Cheung, Jonathan Himmelfarb, Thomas S. Huber, John W. Kusek, Prabir Roy-Chaudhury, Miguel A. Vazquez, Charles E. Alpers, Michelle L. Robbin, Joseph A. Vita, Tom Greene, Jennifer J. Gassman, Harold I. Feldman

Research output: Contribution to journalArticle

65 Citations (Scopus)

Abstract

Background A large proportion of newly created arteriovenous fistulas cannot be used for dialysis because they fail to mature adequately to support the hemodialysis blood circuit. The Hemodialysis Fistula Maturation (HFM) Study was designed to elucidate clinical and biological factors associated with fistula maturation outcomes. Study Design Multicenter prospective cohort study. Setting & Participants Approximately 600 patients undergoing creation of a new hemodialysis fistula will be enrolled at 7 centers in the United States and followed up for as long as 4 years. Predictors Clinical, anatomical, biological, and process-of-care attributes identified pre-, intra-, or postoperatively. Outcomes The primary outcome is unassisted clinical maturation, defined as successful use of the fistula for dialysis for 4 weeks without maturation-enhancing procedures. Secondary outcomes include assisted clinical maturation, ultrasound-based anatomical maturation, fistula procedures, fistula abandonment, and central venous catheter use. Measurements Preoperative ultrasound arterial and venous mapping, flow-mediated and nitroglycerin-mediated brachial artery dilation, arterial pulse wave velocity, and venous distensibility; intraoperative vein tissue collection for histopathologic and molecular analyses; postoperative ultrasounds at 1 day, 2 weeks, 6 weeks, and prior to fistula intervention and initial cannulation. Results Assuming complete data, no covariate adjustment, and unassisted clinical maturation of 50%, there will be 80% power to detect ORs of 1.83 and 1.61 for dichotomous predictor variables with exposure prevalences of 20% and 50%, respectively. Limitations Exclusion of 2-stage transposition fistulas limits generalizability. The requirement for study visits may result in a cohort that is healthier than the overall population of patients undergoing fistula creation. Conclusions The HFM Study will be of sufficient size and scope to: (1) evaluate a broad range of mechanistic hypotheses, (2) identify clinical practices associated with maturation outcomes, (3) assess the predictive utility of early indicators of fistula outcome, and (4) establish targets for novel therapeutic interventions to improve fistula maturation.

Original languageEnglish (US)
Pages (from-to)104-112
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume63
Issue number1
DOIs
StatePublished - 2014

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Fistula
Renal Dialysis
Dialysis
Biological Phenomena
Pulse Wave Analysis
Brachial Artery
Central Venous Catheters
Arteriovenous Fistula
Nitroglycerin
Biological Factors
Catheterization
Multicenter Studies
Dilatation
Veins
Cohort Studies
Prospective Studies

ASJC Scopus subject areas

  • Nephrology

Cite this

Dember, L. M., Imrey, P. B., Beck, G. J., Cheung, A. K., Himmelfarb, J., Huber, T. S., ... Feldman, H. I. (2014). Objectives and design of the hemodialysis fistula maturation study. American Journal of Kidney Diseases, 63(1), 104-112. https://doi.org/10.1053/j.ajkd.2013.06.024

Objectives and design of the hemodialysis fistula maturation study. / Dember, Laura M.; Imrey, Peter B.; Beck, Gerald J.; Cheung, Alfred K.; Himmelfarb, Jonathan; Huber, Thomas S.; Kusek, John W.; Roy-Chaudhury, Prabir; Vazquez, Miguel A.; Alpers, Charles E.; Robbin, Michelle L.; Vita, Joseph A.; Greene, Tom; Gassman, Jennifer J.; Feldman, Harold I.

In: American Journal of Kidney Diseases, Vol. 63, No. 1, 2014, p. 104-112.

Research output: Contribution to journalArticle

Dember, LM, Imrey, PB, Beck, GJ, Cheung, AK, Himmelfarb, J, Huber, TS, Kusek, JW, Roy-Chaudhury, P, Vazquez, MA, Alpers, CE, Robbin, ML, Vita, JA, Greene, T, Gassman, JJ & Feldman, HI 2014, 'Objectives and design of the hemodialysis fistula maturation study', American Journal of Kidney Diseases, vol. 63, no. 1, pp. 104-112. https://doi.org/10.1053/j.ajkd.2013.06.024
Dember, Laura M. ; Imrey, Peter B. ; Beck, Gerald J. ; Cheung, Alfred K. ; Himmelfarb, Jonathan ; Huber, Thomas S. ; Kusek, John W. ; Roy-Chaudhury, Prabir ; Vazquez, Miguel A. ; Alpers, Charles E. ; Robbin, Michelle L. ; Vita, Joseph A. ; Greene, Tom ; Gassman, Jennifer J. ; Feldman, Harold I. / Objectives and design of the hemodialysis fistula maturation study. In: American Journal of Kidney Diseases. 2014 ; Vol. 63, No. 1. pp. 104-112.
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abstract = "Background A large proportion of newly created arteriovenous fistulas cannot be used for dialysis because they fail to mature adequately to support the hemodialysis blood circuit. The Hemodialysis Fistula Maturation (HFM) Study was designed to elucidate clinical and biological factors associated with fistula maturation outcomes. Study Design Multicenter prospective cohort study. Setting & Participants Approximately 600 patients undergoing creation of a new hemodialysis fistula will be enrolled at 7 centers in the United States and followed up for as long as 4 years. Predictors Clinical, anatomical, biological, and process-of-care attributes identified pre-, intra-, or postoperatively. Outcomes The primary outcome is unassisted clinical maturation, defined as successful use of the fistula for dialysis for 4 weeks without maturation-enhancing procedures. Secondary outcomes include assisted clinical maturation, ultrasound-based anatomical maturation, fistula procedures, fistula abandonment, and central venous catheter use. Measurements Preoperative ultrasound arterial and venous mapping, flow-mediated and nitroglycerin-mediated brachial artery dilation, arterial pulse wave velocity, and venous distensibility; intraoperative vein tissue collection for histopathologic and molecular analyses; postoperative ultrasounds at 1 day, 2 weeks, 6 weeks, and prior to fistula intervention and initial cannulation. Results Assuming complete data, no covariate adjustment, and unassisted clinical maturation of 50{\%}, there will be 80{\%} power to detect ORs of 1.83 and 1.61 for dichotomous predictor variables with exposure prevalences of 20{\%} and 50{\%}, respectively. Limitations Exclusion of 2-stage transposition fistulas limits generalizability. The requirement for study visits may result in a cohort that is healthier than the overall population of patients undergoing fistula creation. Conclusions The HFM Study will be of sufficient size and scope to: (1) evaluate a broad range of mechanistic hypotheses, (2) identify clinical practices associated with maturation outcomes, (3) assess the predictive utility of early indicators of fistula outcome, and (4) establish targets for novel therapeutic interventions to improve fistula maturation.",
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T1 - Objectives and design of the hemodialysis fistula maturation study

AU - Dember, Laura M.

AU - Imrey, Peter B.

AU - Beck, Gerald J.

AU - Cheung, Alfred K.

AU - Himmelfarb, Jonathan

AU - Huber, Thomas S.

AU - Kusek, John W.

AU - Roy-Chaudhury, Prabir

AU - Vazquez, Miguel A.

AU - Alpers, Charles E.

AU - Robbin, Michelle L.

AU - Vita, Joseph A.

AU - Greene, Tom

AU - Gassman, Jennifer J.

AU - Feldman, Harold I.

PY - 2014

Y1 - 2014

N2 - Background A large proportion of newly created arteriovenous fistulas cannot be used for dialysis because they fail to mature adequately to support the hemodialysis blood circuit. The Hemodialysis Fistula Maturation (HFM) Study was designed to elucidate clinical and biological factors associated with fistula maturation outcomes. Study Design Multicenter prospective cohort study. Setting & Participants Approximately 600 patients undergoing creation of a new hemodialysis fistula will be enrolled at 7 centers in the United States and followed up for as long as 4 years. Predictors Clinical, anatomical, biological, and process-of-care attributes identified pre-, intra-, or postoperatively. Outcomes The primary outcome is unassisted clinical maturation, defined as successful use of the fistula for dialysis for 4 weeks without maturation-enhancing procedures. Secondary outcomes include assisted clinical maturation, ultrasound-based anatomical maturation, fistula procedures, fistula abandonment, and central venous catheter use. Measurements Preoperative ultrasound arterial and venous mapping, flow-mediated and nitroglycerin-mediated brachial artery dilation, arterial pulse wave velocity, and venous distensibility; intraoperative vein tissue collection for histopathologic and molecular analyses; postoperative ultrasounds at 1 day, 2 weeks, 6 weeks, and prior to fistula intervention and initial cannulation. Results Assuming complete data, no covariate adjustment, and unassisted clinical maturation of 50%, there will be 80% power to detect ORs of 1.83 and 1.61 for dichotomous predictor variables with exposure prevalences of 20% and 50%, respectively. Limitations Exclusion of 2-stage transposition fistulas limits generalizability. The requirement for study visits may result in a cohort that is healthier than the overall population of patients undergoing fistula creation. Conclusions The HFM Study will be of sufficient size and scope to: (1) evaluate a broad range of mechanistic hypotheses, (2) identify clinical practices associated with maturation outcomes, (3) assess the predictive utility of early indicators of fistula outcome, and (4) establish targets for novel therapeutic interventions to improve fistula maturation.

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