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  • Title: Determinants of native arteriovenous fistula blood flow.
    Author: Polkinghorne KR, Atkins RC, Kerr PG.
    Journal: Nephrology (Carlton); 2004 Aug; 9(4):205-11. PubMed ID: 15363051.
    Abstract:
    BACKGROUND: Determinants of native arteriovenous fistula (AVF) placement have been well studied. Little is known on whether these factors impact on subsequent blood flow (Qa) in the mature AVF. METHODS: Arteriovenous fistula Qa and cardiac index (CI) were determined by ultrasound dilution. Multiple linear regression was used to assess independent predictors of AVF Qa. RESULTS: Of the 148 patients available for the analysis, 68% were male, with 61% using a radiocephalic AVF. Aetiology of renal disease was: 38% glomerulonephritis (GN), 22% diabetes mellitus (DM), 9% hypertension/ischaemic (HTN) and 31% other. Thirty per cent had coronary artery disease (CAD), 10% cerebrovascular disease and 11% peripheral vascular disease (PVD). Median (iqr) Qa was 1185 mL/min (790-1650) and CI was 3.15 L/min per 1.73 m(2) (2.60-3.93). On univariable analysis, log CI (0.98, P < 0.001), age (-0.1 per 10 years, P = 0.002), access position (upper vs lower 0.26, P = 0.003, PVD (-0.35, P = 0.015), CAD (-0.25, P = 0.008), and primary renal disease (DM vs GN, -0.35, P = 0.003, HTN vs GN, -0.34, P = 0.04) were associated with Qa. On multivariable analysis, CI (0.84, P < 0.001), access position (upper vs lower, 0.17, P = 0.018) and primary renal disease (DM vs GN, -0.26, P = 0.005, and HTN vs GN, -0.26, P = 0.038) remained significant predictors of AVF Qa. CONCLUSION: Once established, CI, AVF position and primary renal disease (hypertension/ischaemic and diabetes) are the major determinants of AVF Qa while female gender, CAD, PVD and body mass index were not significant determinants of Qa in this cohort.
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