Relationships Between Clinical Processes and Arteriovenous Fistula Cannulation and Maturation

A Multicenter Prospective Cohort Study

Michael Allon, Peter B. Imrey, Alfred K. Cheung, Milena Radeva, Charles E. Alpers, Gerald J. Beck, Laura M. Dember, Alik Farber, Tom Greene, Jonathan Himmelfarb, Thomas S. Huber, James S. Kaufman, John W. Kusek, Prabir Roy-Chaudhury, Michelle L. Robbin, Miguel A. Vazquez, Harold I. Feldman

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Half of surgically created arteriovenous fistulas (AVFs) require additional intervention to effectively support hemodialysis. Postoperative care and complications may affect clinical maturation. Study Design: Hemodialysis Fistula Maturation (HFM) Study, a 7-center prospective cohort study. Setting & Participants: 491 patients with single-stage AVFs who had neither thrombosis nor AVF intervention before a 6-week postoperative ultrasonographic examination and who required maintenance hemodialysis. Predictors: Postoperative care processes and complications. Outcomes: Attempted cannulation, successful cannulation, and unassisted and overall clinical maturation as defined by the HFM Study criteria. Results: AVF cannulation was attempted in 443 of 491 (90.2%) participants and was eventually successful in 430 of these 443 (97.1%) participants. 263 of these 430 (61.2%) reached unassisted and 118 (27.4%) reached assisted AVF maturation (overall maturation, 381/430 [88.6%]). Attempted cannulation was less likely in patients of surgeons with policies for routine 2-week versus later-than-2-week first postoperative visits (OR, 0.21; 95% CI, 0.06-0.70), routine second postoperative follow-up visits (OR, 0.39; 95% CI, 0.15-0.97), and a routine clinical postoperative ultrasound (OR, 0.28; 95% CI, 0.14-0.55). Attempted cannulation was also less likely among patients undergoing procedures to assist maturation (OR, 0.51; 95% CI, 0.27-0.98). Unassisted maturation was more likely for patients treated in facilities with access coordinators (OR, 1.91; 95% CI, 1.17-3.12), but less likely after precannulation nonstudy ultrasounds (OR per ultrasound, 0.42 [95% CI, 0.26-0.68]) and initial unsuccessful cannulation attempts (OR per each additional attempt, 0.90 [95% CI, 0.83-0.98]). Overall maturation was less likely with infiltration before successful cannulation (OR, 0.44; 95% CI, 0.22-0.89). Among participants receiving maintenance hemodialysis before AVF surgery, unassisted and overall maturation were less likely with longer intervals from surgery to initial cannulation (ORs for each additional month of 0.81 [95% CI, 0.76-0.88] and 0.93 [95% CI, 0.89-0.98], respectively) and from initial to successful cannulation (ORs for each additional week of 0.87 [95% CI, 0.81-0.94] and 0.88 [95% CI, 0.83-0.94], respectively). Limitations: Surgeons' management policies were assessed only by questionnaire at study onset. Most participants received upper-arm AVFs, planned 2-stage AVFs were excluded, and maturation time windows were imposed. Some care processes may have been missed and the observational design limits causal attribution. Conclusions: Multiple processes of care and complications are associated with AVF maturation outcomes.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Arteriovenous Fistula
Catheterization
Cohort Studies
Prospective Studies
Renal Dialysis
Postoperative Care
Fistula
Maintenance
Architectural Accessibility
Thrombosis
Arm

Keywords

  • Arteriovenous access
  • Arteriovenous fistula (AVF)
  • Cannulation
  • End-stage renal disease
  • Fistula maturation
  • Hemodialysis
  • Patency
  • Process-of-care
  • Vascular access

ASJC Scopus subject areas

  • Nephrology

Cite this

Relationships Between Clinical Processes and Arteriovenous Fistula Cannulation and Maturation : A Multicenter Prospective Cohort Study. / Allon, Michael; Imrey, Peter B.; Cheung, Alfred K.; Radeva, Milena; Alpers, Charles E.; Beck, Gerald J.; Dember, Laura M.; Farber, Alik; Greene, Tom; Himmelfarb, Jonathan; Huber, Thomas S.; Kaufman, James S.; Kusek, John W.; Roy-Chaudhury, Prabir; Robbin, Michelle L.; Vazquez, Miguel A.; Feldman, Harold I.

In: American Journal of Kidney Diseases, 01.01.2018.

Research output: Contribution to journalArticle

Allon, M, Imrey, PB, Cheung, AK, Radeva, M, Alpers, CE, Beck, GJ, Dember, LM, Farber, A, Greene, T, Himmelfarb, J, Huber, TS, Kaufman, JS, Kusek, JW, Roy-Chaudhury, P, Robbin, ML, Vazquez, MA & Feldman, HI 2018, 'Relationships Between Clinical Processes and Arteriovenous Fistula Cannulation and Maturation: A Multicenter Prospective Cohort Study', American Journal of Kidney Diseases. https://doi.org/10.1053/j.ajkd.2017.10.027
Allon, Michael ; Imrey, Peter B. ; Cheung, Alfred K. ; Radeva, Milena ; Alpers, Charles E. ; Beck, Gerald J. ; Dember, Laura M. ; Farber, Alik ; Greene, Tom ; Himmelfarb, Jonathan ; Huber, Thomas S. ; Kaufman, James S. ; Kusek, John W. ; Roy-Chaudhury, Prabir ; Robbin, Michelle L. ; Vazquez, Miguel A. ; Feldman, Harold I. / Relationships Between Clinical Processes and Arteriovenous Fistula Cannulation and Maturation : A Multicenter Prospective Cohort Study. In: American Journal of Kidney Diseases. 2018.
@article{61180b0fcd14444e84b1ad735917b519,
title = "Relationships Between Clinical Processes and Arteriovenous Fistula Cannulation and Maturation: A Multicenter Prospective Cohort Study",
abstract = "Background: Half of surgically created arteriovenous fistulas (AVFs) require additional intervention to effectively support hemodialysis. Postoperative care and complications may affect clinical maturation. Study Design: Hemodialysis Fistula Maturation (HFM) Study, a 7-center prospective cohort study. Setting & Participants: 491 patients with single-stage AVFs who had neither thrombosis nor AVF intervention before a 6-week postoperative ultrasonographic examination and who required maintenance hemodialysis. Predictors: Postoperative care processes and complications. Outcomes: Attempted cannulation, successful cannulation, and unassisted and overall clinical maturation as defined by the HFM Study criteria. Results: AVF cannulation was attempted in 443 of 491 (90.2{\%}) participants and was eventually successful in 430 of these 443 (97.1{\%}) participants. 263 of these 430 (61.2{\%}) reached unassisted and 118 (27.4{\%}) reached assisted AVF maturation (overall maturation, 381/430 [88.6{\%}]). Attempted cannulation was less likely in patients of surgeons with policies for routine 2-week versus later-than-2-week first postoperative visits (OR, 0.21; 95{\%} CI, 0.06-0.70), routine second postoperative follow-up visits (OR, 0.39; 95{\%} CI, 0.15-0.97), and a routine clinical postoperative ultrasound (OR, 0.28; 95{\%} CI, 0.14-0.55). Attempted cannulation was also less likely among patients undergoing procedures to assist maturation (OR, 0.51; 95{\%} CI, 0.27-0.98). Unassisted maturation was more likely for patients treated in facilities with access coordinators (OR, 1.91; 95{\%} CI, 1.17-3.12), but less likely after precannulation nonstudy ultrasounds (OR per ultrasound, 0.42 [95{\%} CI, 0.26-0.68]) and initial unsuccessful cannulation attempts (OR per each additional attempt, 0.90 [95{\%} CI, 0.83-0.98]). Overall maturation was less likely with infiltration before successful cannulation (OR, 0.44; 95{\%} CI, 0.22-0.89). Among participants receiving maintenance hemodialysis before AVF surgery, unassisted and overall maturation were less likely with longer intervals from surgery to initial cannulation (ORs for each additional month of 0.81 [95{\%} CI, 0.76-0.88] and 0.93 [95{\%} CI, 0.89-0.98], respectively) and from initial to successful cannulation (ORs for each additional week of 0.87 [95{\%} CI, 0.81-0.94] and 0.88 [95{\%} CI, 0.83-0.94], respectively). Limitations: Surgeons' management policies were assessed only by questionnaire at study onset. Most participants received upper-arm AVFs, planned 2-stage AVFs were excluded, and maturation time windows were imposed. Some care processes may have been missed and the observational design limits causal attribution. Conclusions: Multiple processes of care and complications are associated with AVF maturation outcomes.",
keywords = "Arteriovenous access, Arteriovenous fistula (AVF), Cannulation, End-stage renal disease, Fistula maturation, Hemodialysis, Patency, Process-of-care, Vascular access",
author = "Michael Allon and Imrey, {Peter B.} and Cheung, {Alfred K.} and Milena Radeva and Alpers, {Charles E.} and Beck, {Gerald J.} and Dember, {Laura M.} and Alik Farber and Tom Greene and Jonathan Himmelfarb and Huber, {Thomas S.} and Kaufman, {James S.} and Kusek, {John W.} and Prabir Roy-Chaudhury and Robbin, {Michelle L.} and Vazquez, {Miguel A.} and Feldman, {Harold I.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1053/j.ajkd.2017.10.027",
language = "English (US)",
journal = "American Journal of Kidney Diseases",
issn = "0272-6386",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Relationships Between Clinical Processes and Arteriovenous Fistula Cannulation and Maturation

T2 - A Multicenter Prospective Cohort Study

AU - Allon, Michael

AU - Imrey, Peter B.

AU - Cheung, Alfred K.

AU - Radeva, Milena

AU - Alpers, Charles E.

AU - Beck, Gerald J.

AU - Dember, Laura M.

AU - Farber, Alik

AU - Greene, Tom

AU - Himmelfarb, Jonathan

AU - Huber, Thomas S.

AU - Kaufman, James S.

AU - Kusek, John W.

AU - Roy-Chaudhury, Prabir

AU - Robbin, Michelle L.

AU - Vazquez, Miguel A.

AU - Feldman, Harold I.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Half of surgically created arteriovenous fistulas (AVFs) require additional intervention to effectively support hemodialysis. Postoperative care and complications may affect clinical maturation. Study Design: Hemodialysis Fistula Maturation (HFM) Study, a 7-center prospective cohort study. Setting & Participants: 491 patients with single-stage AVFs who had neither thrombosis nor AVF intervention before a 6-week postoperative ultrasonographic examination and who required maintenance hemodialysis. Predictors: Postoperative care processes and complications. Outcomes: Attempted cannulation, successful cannulation, and unassisted and overall clinical maturation as defined by the HFM Study criteria. Results: AVF cannulation was attempted in 443 of 491 (90.2%) participants and was eventually successful in 430 of these 443 (97.1%) participants. 263 of these 430 (61.2%) reached unassisted and 118 (27.4%) reached assisted AVF maturation (overall maturation, 381/430 [88.6%]). Attempted cannulation was less likely in patients of surgeons with policies for routine 2-week versus later-than-2-week first postoperative visits (OR, 0.21; 95% CI, 0.06-0.70), routine second postoperative follow-up visits (OR, 0.39; 95% CI, 0.15-0.97), and a routine clinical postoperative ultrasound (OR, 0.28; 95% CI, 0.14-0.55). Attempted cannulation was also less likely among patients undergoing procedures to assist maturation (OR, 0.51; 95% CI, 0.27-0.98). Unassisted maturation was more likely for patients treated in facilities with access coordinators (OR, 1.91; 95% CI, 1.17-3.12), but less likely after precannulation nonstudy ultrasounds (OR per ultrasound, 0.42 [95% CI, 0.26-0.68]) and initial unsuccessful cannulation attempts (OR per each additional attempt, 0.90 [95% CI, 0.83-0.98]). Overall maturation was less likely with infiltration before successful cannulation (OR, 0.44; 95% CI, 0.22-0.89). Among participants receiving maintenance hemodialysis before AVF surgery, unassisted and overall maturation were less likely with longer intervals from surgery to initial cannulation (ORs for each additional month of 0.81 [95% CI, 0.76-0.88] and 0.93 [95% CI, 0.89-0.98], respectively) and from initial to successful cannulation (ORs for each additional week of 0.87 [95% CI, 0.81-0.94] and 0.88 [95% CI, 0.83-0.94], respectively). Limitations: Surgeons' management policies were assessed only by questionnaire at study onset. Most participants received upper-arm AVFs, planned 2-stage AVFs were excluded, and maturation time windows were imposed. Some care processes may have been missed and the observational design limits causal attribution. Conclusions: Multiple processes of care and complications are associated with AVF maturation outcomes.

AB - Background: Half of surgically created arteriovenous fistulas (AVFs) require additional intervention to effectively support hemodialysis. Postoperative care and complications may affect clinical maturation. Study Design: Hemodialysis Fistula Maturation (HFM) Study, a 7-center prospective cohort study. Setting & Participants: 491 patients with single-stage AVFs who had neither thrombosis nor AVF intervention before a 6-week postoperative ultrasonographic examination and who required maintenance hemodialysis. Predictors: Postoperative care processes and complications. Outcomes: Attempted cannulation, successful cannulation, and unassisted and overall clinical maturation as defined by the HFM Study criteria. Results: AVF cannulation was attempted in 443 of 491 (90.2%) participants and was eventually successful in 430 of these 443 (97.1%) participants. 263 of these 430 (61.2%) reached unassisted and 118 (27.4%) reached assisted AVF maturation (overall maturation, 381/430 [88.6%]). Attempted cannulation was less likely in patients of surgeons with policies for routine 2-week versus later-than-2-week first postoperative visits (OR, 0.21; 95% CI, 0.06-0.70), routine second postoperative follow-up visits (OR, 0.39; 95% CI, 0.15-0.97), and a routine clinical postoperative ultrasound (OR, 0.28; 95% CI, 0.14-0.55). Attempted cannulation was also less likely among patients undergoing procedures to assist maturation (OR, 0.51; 95% CI, 0.27-0.98). Unassisted maturation was more likely for patients treated in facilities with access coordinators (OR, 1.91; 95% CI, 1.17-3.12), but less likely after precannulation nonstudy ultrasounds (OR per ultrasound, 0.42 [95% CI, 0.26-0.68]) and initial unsuccessful cannulation attempts (OR per each additional attempt, 0.90 [95% CI, 0.83-0.98]). Overall maturation was less likely with infiltration before successful cannulation (OR, 0.44; 95% CI, 0.22-0.89). Among participants receiving maintenance hemodialysis before AVF surgery, unassisted and overall maturation were less likely with longer intervals from surgery to initial cannulation (ORs for each additional month of 0.81 [95% CI, 0.76-0.88] and 0.93 [95% CI, 0.89-0.98], respectively) and from initial to successful cannulation (ORs for each additional week of 0.87 [95% CI, 0.81-0.94] and 0.88 [95% CI, 0.83-0.94], respectively). Limitations: Surgeons' management policies were assessed only by questionnaire at study onset. Most participants received upper-arm AVFs, planned 2-stage AVFs were excluded, and maturation time windows were imposed. Some care processes may have been missed and the observational design limits causal attribution. Conclusions: Multiple processes of care and complications are associated with AVF maturation outcomes.

KW - Arteriovenous access

KW - Arteriovenous fistula (AVF)

KW - Cannulation

KW - End-stage renal disease

KW - Fistula maturation

KW - Hemodialysis

KW - Patency

KW - Process-of-care

KW - Vascular access

UR - http://www.scopus.com/inward/record.url?scp=85041584455&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85041584455&partnerID=8YFLogxK

U2 - 10.1053/j.ajkd.2017.10.027

DO - 10.1053/j.ajkd.2017.10.027

M3 - Article

JO - American Journal of Kidney Diseases

JF - American Journal of Kidney Diseases

SN - 0272-6386

ER -