An arteriovenous fistula (AVF) is the guideline-recommended vascular access for hemodialysis, yet a large majority of patients in the US and Canada begin dialysis using catheter access, despite its higher rates of complications. Because patients resist having the AVF surgical procedure, many nephrologists have looked to the results of observational studies that led to the hypothesis that AVF creation could affect kidney function—and even lead to benefits that could postpone the need for dialysis.
Definitive evidence for such a benefit remains elusive, however, with two new studies contributing to the discussion in conflicting ways, and providing no firm answers. A study from Canada provided more observational evidence that the creation of an AVF slows a patient’s slide toward dialysis, whereas one from Sweden found the same benefits from the placement of either an AVF or a peritoneal dialysis catheter.
The first report, published in November 2019 in BMC Nephrology by Annie-Claire Nadeau-Fredette, MD, et al., was a retrospective cohort study of 146 patients in Quebec whose estimated glomerular filtration rates (eGFR) were followed pre- and post-AVF creation. The study found that “AVF creation was associated with a significant reduction in eGFR decline.” The results echo the findings of several other observational studies.
But a somewhat contrasting study from the Karolinska Institute in Sweden, published in October 2019 in Nephrology Dialysis Transplantation by Ulrika Hahn Lundstrom et al., compared the effects of AVF placement with peritoneal dialysis catheter placement in 744 pre-dialysis patients. The study found that “both forms of access were associated with reduced eGFR decline [with] no significant difference in eGFR decline” between the two procedures.