Arteriovenous fistula (AVF) creation is associated with a slowing of kidney function decline in patients with chronic kidney disease (CKD), new study findings suggest.
Investigators retrospectively matched 61 patients with an AVF to 61 patients with a peritoneal dialysis (PD) catheter using a propensity score. Time zero was defined as the AVF creation date for each AVF patient and the date when the estimated glomerular filtration rate (eGFR) of the corresponding PD patient most closely matched the eGFR at AVF surgery. None had initiated dialysis.
Before access surgery, the annual decline in crude eGFR did not differ significantly between groups: -4.1 mL/min/1.73 m2 in the AVF group and -5.3 mL/min/1.73 m2 in the PD group. After time zero, investigators observed significantly slower eGFR decline in the AVF than PD group: -2.5 vs -4.5 mL/min/1.73 m2 per year, respectively, Annie-Claire Nadeau-Fredette, MD, MSc, of Maisonneuve-Rosemont Hospital in Montreal, Quebec, Canada, and collaborators reported in Kidney 360. In the AVF group, annual kidney function decline decreased by a significant 1.7 mL/min/1.73 m2 after access creation, they noted.
The investigators observed the same trends using predicted eGFR. In the AVF group, predicted annual eGFR decline slowed significantly from -5.1 mL/min/1.73 m2 per year before AVF surgery to -2.8 mL/min/1.73 m2 per year after vascular access creation. Dr. Nadeau-Fredette’s team found no significant difference in predicted decline in the PD group, however: -5.5 vs -5.1 mL/min/1.73 m2 per year, respectively.
Dr. Nadeau-Fredette and colleagues concluded that their study found that patients who were predialysis in this cohort had a slower kidney decline after AVF creation than matched patients who were PD-oriented, pointing toward a potential association between AVF creation and preservation of kidney function. “Considering the limitations of observational data, multicenter trials should be performed to further assess this hypothesis, considering the psychosocial, economic, and clinical benefits of residual kidney function preservation in advanced CKD,” they wrote.
In an accompanying editorial, Thomas A. Golper, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, cited similar research and agreed that the slowing of renal function decline after AVF creation appears to be real. Several potential mechanisms have been proposed but need to be clarified.
“Clinicians understand the difficulty in persuading some patients to agree to timely AVF creation,” he noted. “The possibility that this maneuver might delay hemodialysis may be the persuasive tip-over rationale for the reluctant patient to have an AVF created in a timely manner.”