Patient-related factors influencing patency of autogenous brachiocephalic haemodialysis fistulas

Objective: The objective of this study was to analyse the outcome of autogenous brachiocephalic fistula for dialysis purposes and to determine modifiable and non-modifiable patient-related factors of influence on the patency of a newly created fistula.

Design of study: A single-centre retrospective cohort study with the aim of determining patient-related factors of influence on primary failure, primary, primary assisted and secondary patency of autogenous brachiocephalic fistulas. Seventeen patient-related variables were determined by means of univariate analysis, variables reaching significance were then entered in a multivariate Cox-regression model.

Results: Between October 2005-October 2015, 231 autogenous brachiocephalic fistulas were created in 228 patients. Mean age was 61.3 years (20.3-88.2 years). Patency was calculated using Kaplan-Meier analysis. Primary failure occurred in 38 out of 231 created fistulas (16.5%). The primary, primary assisted and secondary patency rates at six months were 78 +/- 3%, 93 +/- 2%, and 95 +/- 1%, respectively. At 12 months, they were 63 +/- 3%, 89 +/- 2%, and 92 +/- 2%, and at 24 months 47 +/- 4%, 84 +/- 3%, and 89 +/- 2%. The non-modifiable factors, diabetes mellitus and mean cephalic vein diameter were identified as a predictor for failure influencing primary and secondary patency. The preoperative use of anticoagulation was identified as a modifiable factor for failure.

Conclusions: This study identified several non-modifiable and modifiable factors of interest to the clinician deciding on which type of haemodialysis fistula is most suitable for an individual patient. Meticulous preoperative work-up, a surveillance programme, and a dedicated multidisciplinary team can be of great importance in achieving better patency rates.