Arteriovenous fistula non-use: Insights from Thailand’s healthcare experience

Abstract

Background:

While arteriovenous fistulas (AVFs) are preferred for hemodialysis access, the impact of prior central venous catheter (CVC) use on AVF outcomes and health-related quality of life (HRQoL) remain unclear. This study compared composite AVF non-use and complications between patients with prior CVC use and those with preemptive AVF creation over 24 months.

Methods:

This prospective longitudinal study consecutively enrolled patients with chronic kidney disease (CKD) referral for attended long-term vascular access planning consultations at two tertiary hospitals in northern Thailand (2016–2017). Eligible participants (⩾18 years) undergoing first-time AVF creation were categorized into CVC (first hemodialysis via CVC) and non-CVC (preemptive AVF) groups. Baseline characteristics were compared between groups. Multivariable logistic regression with backward stepwise selection identified predictors of composite AVF non-use in an exploratory analysis. Outcomes included composite AVF non-use (AVF non-use, hemodialysis suitability failure, and early mortality within 12 months), complications, and HRQoL.

Results:

Among 167 patients (73 CVC, 94 non-CVC), AVF non-use at 12 months was significantly higher in the non-CVC group (32.9% vs 4.7%, p < 0.001), resulting in lower composite AVF non-use in the CVC group (19.2% vs 47.9%, p < 0.001). Each 1 mL/min/1.73 m² eGFR increase raised composite non-use risk by 7%, while prior CVC use reduced it by 22%. The CVC group had more symptomatic central vein stenosis (11.0% vs 3.2%, p = 0.060) but similar mortality rates. HRQoL improved physically in the CVC group by 18 months, with mental improvements in both groups by 24 months.

Conclusions:

Prior CVC use was associated with lower AVF non-use, reflecting better timing of AVF creation based on established dialysis need rather than CVC benefits. High preemptive AVF non-use often resulted from delayed dialysis initiation or changing preferences. These findings support kidney failure risk prediction tools and individualized ESRD life-planning to optimize AVF timing. For patients requiring urgent dialysis initiation, sequential CVC-to-AVF management may represent clinically appropriate care. Optimal results require individualized timing, ongoing reassessment, and strong multidisciplinary coordination.