Prediction of arteriovenous fistula clinical maturation from postoperative ultrasound measurements: Findings from the Hemodialysis Fistula Maturation Study

Hemodialysis Fistula Maturation Study Group

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: The utility of early postoperative ultrasound measurements in predicting arteriovenous fistula (AVF) clinical maturation is uncertain. Methods: We investigated the relationships of ultrasound parameters with AVF clinical maturation in newly created AVF, measured at 1 day and 2 and 6 weeks, in 602 participants of a multicenter, observational cohort study. A backward elimination algorithm identified ultrasound measurements that independently predicted unassisted and overall AVF maturation. Candidate variables included AVF blood flow, diameter, and depth, upper arm arterial diameter, presence of stenosis, presence of accessory veins, seven case-mix factors (age, sex, black race, AVF location, diabetes, dialysis status, and body mass index), and clinical center. We evaluated the accuracy of the resulting models for clinical prediction. Results: At each ultrasound measurement time, AVF blood flow, diameter, and depth each predicted in a statistically significant manner both unassisted and overall clinical maturation. Moreover, neither the remaining ultrasound parameters nor case-mix factors were associated with clinical AVF maturation after accounting for blood flow, diameter, and depth, althoughmaturation probabilities differed among clinical centers before and after accounting for these parameters. The crossvalidated area under the receiver operating characteristic curve for models constructed using these three ultrasound parameters was 0.69, 0.74, and 0.79 at 1 day and 2 and 6 weeks, respectively, for unassisted AVF clinical maturation and 0.69, 0.71, and 0.76, respectively, for overall AVF maturation. Conclusions: AVF blood flow, diameter, and depth moderately predicted unassisted and overall AVF clinical maturation. The other factors considered did not further improve AVF maturation prediction.

Original languageEnglish (US)
Pages (from-to)2735-2744
Number of pages10
JournalJournal of the American Society of Nephrology
Volume29
Issue number11
DOIs
StatePublished - Nov 1 2018

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Arteriovenous Fistula
Fistula
Renal Dialysis
Diagnosis-Related Groups
Sex Factors
Age Factors
ROC Curve
Observational Studies
Dialysis
Veins
Pathologic Constriction
Body Mass Index
Arm
Cohort Studies

ASJC Scopus subject areas

  • Nephrology

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Prediction of arteriovenous fistula clinical maturation from postoperative ultrasound measurements : Findings from the Hemodialysis Fistula Maturation Study. / Hemodialysis Fistula Maturation Study Group.

In: Journal of the American Society of Nephrology, Vol. 29, No. 11, 01.11.2018, p. 2735-2744.

Research output: Contribution to journalArticle

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title = "Prediction of arteriovenous fistula clinical maturation from postoperative ultrasound measurements: Findings from the Hemodialysis Fistula Maturation Study",
abstract = "Background: The utility of early postoperative ultrasound measurements in predicting arteriovenous fistula (AVF) clinical maturation is uncertain. Methods: We investigated the relationships of ultrasound parameters with AVF clinical maturation in newly created AVF, measured at 1 day and 2 and 6 weeks, in 602 participants of a multicenter, observational cohort study. A backward elimination algorithm identified ultrasound measurements that independently predicted unassisted and overall AVF maturation. Candidate variables included AVF blood flow, diameter, and depth, upper arm arterial diameter, presence of stenosis, presence of accessory veins, seven case-mix factors (age, sex, black race, AVF location, diabetes, dialysis status, and body mass index), and clinical center. We evaluated the accuracy of the resulting models for clinical prediction. Results: At each ultrasound measurement time, AVF blood flow, diameter, and depth each predicted in a statistically significant manner both unassisted and overall clinical maturation. Moreover, neither the remaining ultrasound parameters nor case-mix factors were associated with clinical AVF maturation after accounting for blood flow, diameter, and depth, althoughmaturation probabilities differed among clinical centers before and after accounting for these parameters. The crossvalidated area under the receiver operating characteristic curve for models constructed using these three ultrasound parameters was 0.69, 0.74, and 0.79 at 1 day and 2 and 6 weeks, respectively, for unassisted AVF clinical maturation and 0.69, 0.71, and 0.76, respectively, for overall AVF maturation. Conclusions: AVF blood flow, diameter, and depth moderately predicted unassisted and overall AVF clinical maturation. The other factors considered did not further improve AVF maturation prediction.",
author = "{Hemodialysis Fistula Maturation Study Group} and Robbin, {Michelle L.} and Tom Greene and Michael Allon and Dember, {Laura M.} and Imrey, {Peter B.} and Cheung, {Alfred K.} and Jonathan Himmelfarb and Huber, {Thomas S.} and Kaufman, {James S.} and Radeva, {Milena K.} and Prabir Roy-Chaudhury and Shiu, {Yan Ting} and Vazquez, {Miguel A} and Umphrey, {Heidi R.} and Lauren Alexander and Carl Abts and Beck, {Gerald J.} and Kusek, {John W.} and Feldman, {Harold I.}",
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T1 - Prediction of arteriovenous fistula clinical maturation from postoperative ultrasound measurements

T2 - Findings from the Hemodialysis Fistula Maturation Study

AU - Hemodialysis Fistula Maturation Study Group

AU - Robbin, Michelle L.

AU - Greene, Tom

AU - Allon, Michael

AU - Dember, Laura M.

AU - Imrey, Peter B.

AU - Cheung, Alfred K.

AU - Himmelfarb, Jonathan

AU - Huber, Thomas S.

AU - Kaufman, James S.

AU - Radeva, Milena K.

AU - Roy-Chaudhury, Prabir

AU - Shiu, Yan Ting

AU - Vazquez, Miguel A

AU - Umphrey, Heidi R.

AU - Alexander, Lauren

AU - Abts, Carl

AU - Beck, Gerald J.

AU - Kusek, John W.

AU - Feldman, Harold I.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: The utility of early postoperative ultrasound measurements in predicting arteriovenous fistula (AVF) clinical maturation is uncertain. Methods: We investigated the relationships of ultrasound parameters with AVF clinical maturation in newly created AVF, measured at 1 day and 2 and 6 weeks, in 602 participants of a multicenter, observational cohort study. A backward elimination algorithm identified ultrasound measurements that independently predicted unassisted and overall AVF maturation. Candidate variables included AVF blood flow, diameter, and depth, upper arm arterial diameter, presence of stenosis, presence of accessory veins, seven case-mix factors (age, sex, black race, AVF location, diabetes, dialysis status, and body mass index), and clinical center. We evaluated the accuracy of the resulting models for clinical prediction. Results: At each ultrasound measurement time, AVF blood flow, diameter, and depth each predicted in a statistically significant manner both unassisted and overall clinical maturation. Moreover, neither the remaining ultrasound parameters nor case-mix factors were associated with clinical AVF maturation after accounting for blood flow, diameter, and depth, althoughmaturation probabilities differed among clinical centers before and after accounting for these parameters. The crossvalidated area under the receiver operating characteristic curve for models constructed using these three ultrasound parameters was 0.69, 0.74, and 0.79 at 1 day and 2 and 6 weeks, respectively, for unassisted AVF clinical maturation and 0.69, 0.71, and 0.76, respectively, for overall AVF maturation. Conclusions: AVF blood flow, diameter, and depth moderately predicted unassisted and overall AVF clinical maturation. The other factors considered did not further improve AVF maturation prediction.

AB - Background: The utility of early postoperative ultrasound measurements in predicting arteriovenous fistula (AVF) clinical maturation is uncertain. Methods: We investigated the relationships of ultrasound parameters with AVF clinical maturation in newly created AVF, measured at 1 day and 2 and 6 weeks, in 602 participants of a multicenter, observational cohort study. A backward elimination algorithm identified ultrasound measurements that independently predicted unassisted and overall AVF maturation. Candidate variables included AVF blood flow, diameter, and depth, upper arm arterial diameter, presence of stenosis, presence of accessory veins, seven case-mix factors (age, sex, black race, AVF location, diabetes, dialysis status, and body mass index), and clinical center. We evaluated the accuracy of the resulting models for clinical prediction. Results: At each ultrasound measurement time, AVF blood flow, diameter, and depth each predicted in a statistically significant manner both unassisted and overall clinical maturation. Moreover, neither the remaining ultrasound parameters nor case-mix factors were associated with clinical AVF maturation after accounting for blood flow, diameter, and depth, althoughmaturation probabilities differed among clinical centers before and after accounting for these parameters. The crossvalidated area under the receiver operating characteristic curve for models constructed using these three ultrasound parameters was 0.69, 0.74, and 0.79 at 1 day and 2 and 6 weeks, respectively, for unassisted AVF clinical maturation and 0.69, 0.71, and 0.76, respectively, for overall AVF maturation. Conclusions: AVF blood flow, diameter, and depth moderately predicted unassisted and overall AVF clinical maturation. The other factors considered did not further improve AVF maturation prediction.

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