Kidney diseases (Basel, Switzerland) · 2026
Predictors of Balloon-Assisted Arteriovenous Fistula Maturation: Importance of Intervention Timing and Blood Flow.
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Wan Ziming, Yang Hongwei, Lai Qiquan, Gao Xuejing, Chen Ling, Zhang Xi, Gan Hua
Аннотация
INTRODUCTION: Balloon-assisted maturation (BAM) improves the success rate of arteriovenous fistula (AVF) creation. However, the optimal timing of BAM and the factors influencing its success remain unclear. This study aimed to evaluate the clinical success rate of BAM and identify related influencing factors.
METHODS: A total of 991 patients undergoing BAM due to AVF immaturity were included (2017-2023) in this study. Data on patient demographics, AVF characteristics, procedural details, brachial artery ultrasound parameters, and preoperative serological indicators were collected. Logistic regression analyses identified factors associated with functional maturation.
RESULTS: The overall assisted maturation rate was 94.15%. An AVF creation-to-BAM interval of <90 days (odds ratio [OR] = 0.413, p = 0.006), prolonged thrombin time (OR = 0.209, p = 0.007), and elevated D-dimer levels (OR = 0.227, p = 0.006) were associated with a reduced maturation rate. A preoperative brachial blood flow ≥300 mL/min (OR = 2.886, p = 0.003) and a postoperative flow ≥830 mL/min (OR = 2.590, p = 0.002) were protective. Combining all 5 factors yielded an area under the curve of 0.786. In patients aged <65 years, upper arm AVF location (OR = 0.172, p = 0.022) and elevated gamma-glutamyl transferase (OR = 0.233, p = 0.009) were adverse factors. In patients aged ≥65 years, a low serum calcium level (OR = 0.403, p = 0.026) was an additional risk factor. Meanwhile, the AVF creation-to-BAM interval (age <65 years: OR = 0.307, p = 0.028; age ≥65 years, OR = 0.423, p = 0.045) and postoperative brachial flow (age <65 years: OR = 5.876, p = 0.001; age ≥65 years, OR = 2.516, p = 0.039) remained independent factors affecting AVF maturation.
CONCLUSION: BAM is an effective intervention for immature AVFs. A longer interval from AVF creation to BAM and higher postoperative brachial flow are associated with increased AVF maturation rates, especially in younger patients.
METHODS: A total of 991 patients undergoing BAM due to AVF immaturity were included (2017-2023) in this study. Data on patient demographics, AVF characteristics, procedural details, brachial artery ultrasound parameters, and preoperative serological indicators were collected. Logistic regression analyses identified factors associated with functional maturation.
RESULTS: The overall assisted maturation rate was 94.15%. An AVF creation-to-BAM interval of <90 days (odds ratio [OR] = 0.413, p = 0.006), prolonged thrombin time (OR = 0.209, p = 0.007), and elevated D-dimer levels (OR = 0.227, p = 0.006) were associated with a reduced maturation rate. A preoperative brachial blood flow ≥300 mL/min (OR = 2.886, p = 0.003) and a postoperative flow ≥830 mL/min (OR = 2.590, p = 0.002) were protective. Combining all 5 factors yielded an area under the curve of 0.786. In patients aged <65 years, upper arm AVF location (OR = 0.172, p = 0.022) and elevated gamma-glutamyl transferase (OR = 0.233, p = 0.009) were adverse factors. In patients aged ≥65 years, a low serum calcium level (OR = 0.403, p = 0.026) was an additional risk factor. Meanwhile, the AVF creation-to-BAM interval (age <65 years: OR = 0.307, p = 0.028; age ≥65 years, OR = 0.423, p = 0.045) and postoperative brachial flow (age <65 years: OR = 5.876, p = 0.001; age ≥65 years, OR = 2.516, p = 0.039) remained independent factors affecting AVF maturation.
CONCLUSION: BAM is an effective intervention for immature AVFs. A longer interval from AVF creation to BAM and higher postoperative brachial flow are associated with increased AVF maturation rates, especially in younger patients.