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Outcomes of patients commencing peritoneal dialysis with and without back-up arteriovenous fistulas

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Abstract

Background

Transitions from peritoneal dialysis (PD) to haemodialysis (HD) are often unpredictable and central venous catheters (CVCs) are frequently required. Early studies found few back-up arteriovenous fistulas (bAVFs) were ever used. The PD population’s characteristics have changed over time which may have altered the likelihood of bAVFs being used. This study aimed to report use of, and outcomes associated with, bAVFs in a contemporary cohort of peritoneal dialysis patients.

Method

A single-centre, retrospective study of PD patients commencing dialysis between 2006–2016, stratified according to presence/absence of bAVF.

Results

One hundred seventy-six patients were included—82 with bAVF, 94 without bAVF—of whom 156 transitioned off PD. Transitions were to HD (49%), transplantation (23%), death (15%) and renal-recovery (1%). 51% of bAVFs were successfully used and 82% of bAVFs were patent when required. Median time from creation to bAVF use was 2.5 years. More patients with a bAVF transitioned to HD (62 vs 38%, p < 0.005). However, CVC requirement at the time of transition to HD was much less common in the bAVF group (18 vs 83%, p < 0.0001), such that the overall risk of requiring a CVC was significantly lower in the bAVF group (11 vs 31%, p < 0.005). Rates of returning to PD amongst patients who transitioned to HD with a CVC or an AVF were similar (19 vs 26%, p = 0.16).

Conclusions

In this cohort of PD patients, utilisation of back-up arteriovenous fistulas was higher than previously reported, and presence of a back-up arteriovenous fistula was associated with a lower rate of future CVC use.

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Deidentified data is available from the corresponding author.

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Acknowledgements

The authors of the manuscript would like to acknowledge the following for their assistance with this project: Leonid Churilov, biostatistician; the ANZDATA registry; the nursing staff and patients of the Austin Health Home Therapies Centre.

Funding

No funding was received for this study from any source.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Melbourne, Melbourne, Australia

    Evangelia Haralabopoulos, Peter F. Mount & Matthew R. P. Davies

  2. Department of Nephrology, Austin Health, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia

    Madeleine M. Cosgrave, Peter F. Mount & Matthew R. P. Davies

  3. Kidney Laboratory, Institute for Breathing and Sleep, Austin Health, Heidelberg, Australia

    Peter F. Mount

Authors
  1. Evangelia Haralabopoulos
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  2. Madeleine M. Cosgrave
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  3. Peter F. Mount
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  4. Matthew R. P. Davies
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Contributions

EH: data collection and analysis; first draft of manuscript. MMC: data collection and analysis. PFM: data analysis and interpretation; manuscript revision. MRPD: study idea and oversight; data analysis and interpretation; manuscript revision.

Corresponding author

Correspondence to Matthew R. P. Davies.

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None of the authors have any conflicts of interest to declare.

Ethics approval

The methodology of this retrospective study was granted ethical approval by Austin Health Human Research Ethics Committee.

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Haralabopoulos, E., Cosgrave, M.M., Mount, P.F. et al. Outcomes of patients commencing peritoneal dialysis with and without back-up arteriovenous fistulas. J Nephrol 34, 89–95 (2021). https://doi.org/10.1007/s40620-020-00834-w

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  • DOI: https://doi.org/10.1007/s40620-020-00834-w

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