Incidence and Risk Factors of Primary Arteriovenous Access Failure in Dialysis Patients: A National-Based Retrospective Cohort Study

Abstract

Background and Aim: The demand for hemodialysis (HD) among patients with end-stage kidney disease (ESKD) is rising globally. A well-functioning vascular access (VA) is crucial for effective dialysis therapy. This study aims to determine the incidence and risk factors of primary arterio-venous access (AVA) maturation failure in HD patients. Methods: This retrospective cohort study included adult HD patients who underwent AVA creation between 01/01/2021 and 31/12/2023 in Qatar. Data, including demographics, medical comorbidities, AVA type, time to maturation, and incidence of AVA failure, were obtained from a national electronic health record system. Results: Among 242 AVA creations, the primary AVA failure rate was 28%, with an incidence of 9.3 per 100 cases per year. Failure was significantly higher in older patients (p < 0.001), those with diabetes mellitus (p = 0.03), atherosclerosis (p = 0.02), and lower systolic and diastolic blood pressures (p = 0.02 and p < 0.001, respectively). Statin use was higher in patients with matured AVA (68.9% vs. 45.5%; p < 0.001). Multivariate analysis identified diabetes mellitus [OR: 3.672 (95%CI: 1.532–8.801); p = 0.004], atherosclerosis [OR: 2.348 (95%CI: 1.001–5.504); p = 0.002], and age [OR: 1.036 (95%CI: 1.010–1.064); p = 0.007] as risk factors for failure. Statin use [OR: 0.167 (95%CI: 0.080–0.347); p < 0.001] and higher systolic blood pressure [OR: 0.989 (95%CI: 0.966–1.000); p = 0.05] were protective factors. Conclusion: Primary AVA failure in hemodialysis patients in Qatar is notably high, with advanced age, diabetes, atherosclerosis, and low blood pressure increasing risk. Statin use and higher systolic blood pressure provide protective effects. These findings highlight the need for managing risk factors to improve AVA maturation success and enhance dialysis outcomes.