Fistula placement pre-dialysis can help maintain eGFR

WASHINGTON — Placement of an arteriovenous fistula in patients with chronic kidney disease not on dialysis can help stabilize GFR, according to a study presented here during ASN Kidney Week.

“We wanted to try and respond to the criticism that it may be the natural history of kidney disease that reduces GFR,” Marie-Eve Dupris, MD, of Hopital Maisonneuve-Rosemont in Montreal, and co-author on the study, told Healio Nephrology.

“Arteriovenous fistula placement has been associated with potential attenuation of eGFR decline. Uncertainty remained as to whether this association is specifically related to AVF or rather involves confounding, such as natural change in eGFR decline,” Dupris and her colleagues reported.

In the study, approximately 50 incident patients with an AVF placement who were followed in a CKD clinic were matched by age, sex, race, diabetes and eGFR to patients who had a peritoneal dialysis catheter.

“We believe that using patients who were on PD would be a healthier group for a comparison than patients who had an IV catheter,” Dupris said.

The researchers used mixed-effect linear regression models to predict eGFR in the AVF- and PD-matched groups.

In their poster for the study, the authors noted GFRs were calculated using the CKD-EPI equation.

“Baseline characteristics of the 47 patients with AVF and 47 patients with PD catheter installation were globally similar,” they wrote. “Median eGFR at time of AVF creation was 11.4 ml/min/1.73m² (and 11.9 ml/min/1.73m² in matched PD group). Predicted eGFR decreased by 0.4 ml/min per month in both groups.”

There was an attenuation in eGFR decline each additional month after AVF creation/match-point, the authors wrote but “but the period after AVF creation (or match-point) was associated with a fixed increase in predicted eGFR only for the AVF group (B 1.01, P<.001).”

Dupris said while it appeared both the patients on PD and those with an AVF saw benefits in maintained the eGFR, those with the AVF saw greater improvement.

“In this matched cohort study, placement of AVF was associated with an increase in predicted eGFR in the AVF group only. There was, however, an attenuation of monthly eGFR decline in both groups with progression of advanced CKD,” the authors wrote. “Overall, this study supports other findings suggesting a contribution of AVF in the stabilization of eGFR decline.”– by Mark E. Neumann

Reference:

Dupuis ME, et al. Abstract TH-PO412. Presented at: ASN Kidney Week; Nov. 7-10, 2019; Washington, D.C.

Disclosures: The authors report no relevant financial disclosures.