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J Am Soc Nephrol. 2018 Nov;29(11):2735-2744. doi: 10.1681/ASN.2017111225. Epub 2018 Oct 11.

Prediction of Arteriovenous Fistula Clinical Maturation from Postoperative Ultrasound Measurements: Findings from the Hemodialysis Fistula Maturation Study.

Author information

1
Department of Radiology and mrobbin@uabmc.edu.
2
Departments of Population Health Sciences and.
3
Internal Medicine and.
4
Division of Nephrology, University of Alabama at Birmingham, Birmingham, Alabama.
5
Renal, Electrolyte and Hypertension Division, Department of Medicine, and Center for Clinical Epidemiology and Biostatistics, and Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
6
Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
7
Cleveland Clinic Lerner College of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
8
Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah.
9
Division of Nephrology and Hypertension, University of Utah, Salt Lake City, Utah.
10
Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
11
Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington.
12
Division of Vascular Surgery, University of Florida College of Medicine, Gainesville, Florida.
13
Renal Section, Veterans Affairs New York Harbor Healthcare System, New York, New York.
14
Division of Nephrology, New York University School and Medicine, New York, New York.
15
Division of Nephrology, University of Arizona College of Medicine, Tucson, Arizona.
16
Division of Nephrology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
17
Department of Radiology and.
18
Department of Radiology, Mayo Clinic, Jacksonville, Florida.
19
Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
20
Department of Biostatistics and Epidemiology, Department of Medicine, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

Erratum in

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, although maturation 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.

KEYWORDS:

Ultrasonography; access blood flow; arteriovenous fistula; clinical trial; dialysis access; hemodialysis

Comment in

PMID:
30309898
PMCID:
PMC6218859
DOI:
10.1681/ASN.2017111225
[Indexed for MEDLINE]
Free PMC Article

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