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, 8 (2)

The Prognostic Significance of Puncture Timing to Survival of Arteriovenous Fistulas in Hemodialysis Patients: A Multicenter Retrospective Cohort Study

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The Prognostic Significance of Puncture Timing to Survival of Arteriovenous Fistulas in Hemodialysis Patients: A Multicenter Retrospective Cohort Study

Su-Ju Lin et al. J Clin Med.

Abstract

(1) Background: A functional shunt is critical to hemodialysis, but the ideal timing of shunt cannulation is still not established. In this study, we assessed the association between ideal puncture timing and shunt survival. (2) Methods: This retrospective cohort study using data from the Taiwan Health and Welfare database, which included 26885 hemodialysis patients with arteriovenous fistulas from 1 July 2008 to 30 June 2012. Fistulas were categorized by functional maturation time, defined as the time from the date of shunt construction to the first successful cannulation. Functional cumulative survival, measured as the duration from the first puncture to shunt abandonment, was mainly regarded. (3) Results: The fistulas created between 91 and 180 days prior to the first cannulation had significantly greater cumulative functional survival (HR 0.883; 95% CI 0.792⁻0.984), and there was no more benefit on their survival from waiting more than 180 days (HR 0.957; 95% CI 0.853⁻1.073) for shunt maturity. (4) Conclusions: Our results showed that to achieve better long-term shunt survivals, fistulas should be constructed at least 90 days before starting hemodialysis. Notably, there was no additional benefit on waiting more than 180 days prior to cannulation.

Keywords: arteriovenous fistula; hemodialysis; maturation time; puncture time; survival.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart of patients enrolled from National Health Insurance Research Database (NHIRD).
Figure 2
Figure 2
Definitions of shunt survival. a Functional maturation: shunt is cannulated for hemodialysis successfully.
Figure 3
Figure 3
Functional cumulative survival and primary patency of fistulas.
Figure 4
Figure 4
Adjusted Kaplan–Meier plots for (a) functional cumulative survival and (b) primary patency of fistulas. The model was adjusted for age, gender, history of hypertension, diabetes mellitus, myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, and use of aspirin, clopidogrel, warfarin, and statins.
Figure 5
Figure 5
Subgroup hazard ratio for short survival. AVF (arteriovenous fistula) creation [<90 days as reference].

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