Predictors of Primary Arteriovenous Fistula Failure in Patients With End-Stage Renal Disease: A Single-Centre Retrospective Cohort.

BACKGROUND

Arteriovenous fistula (AVF) is the preferred vascular access for haemodialysis, yet primary failure remains common and its determinants in Southeast Asian populations are incompletely characterised.

METHODS

We retrospectively analysed 151 AVFs created in 125 adults with end-stage renal disease (ESRD) at a tertiary hospital (2020-2022). The primary outcome was AVF failure, defined as an access that never became usable for haemodialysis (primary non-function, early occlusion, or non-maturation).

RESULTS

Primary failure occurred in 34/151 fistulas (22.5%). Failure rates differed by configuration: 9.3% for brachiocephalic, 26.0% for radiocephalic (wrist), and 50.0% for brachiobasilic fistulas (p = 0.011). Lower BMI was associated with failure (21.3 ± 2.9 vs. 22.9 ± 3.7 kg/m2; p = 0.010). In multivariable analysis, higher BMI was independently protective (adjusted odds ratio [aOR] 0.84 per kg/m2, 95% CI 0.72-0.97; p = 0.016), and a proximal (brachial-based) anastomosis showed a protective trend (aOR 0.42, 95% CI 0.17-1.05; p = 0.063). Preoperative brachial-artery and cephalic-vein diameters, age, sex, diabetes, and heart failure were not associated with failure. The model was well calibrated (Hosmer-Lemeshow p = 0.66) with modest discrimination (AUC 0.69, 95% CI 0.59-0.79).

CONCLUSIONS

Low BMI was associated with a higher risk of primary AVF failure. The observed differences among AVF configurations should be interpreted with caution because the choice of access type was likely influenced by patient and vascular characteristics. Preoperative vessel diameter, however, was not significantly associated with failure in this cohort.