Arteriovenous Fistula Creation and Estimated Glomerular Filtration Rate Decline in Advanced CKD: A Matched Cohort Study

Background Kidney failure is associated with ahigh burden of morbidity and mortality. Previous studies have raised the possibility that arteriovenous fi stula (AVF) creation may attenuate eGFR decline. This study aimed to compare eGFR decline in predialysis patients with an AVF, matched to patients oriented toward peritoneal dialysis (PD). Methods Predialysis patients with an AVF and those oriented toward PD were retrospectively matched using a propensity score. Time zero was de fi ned as the “ AVF creation date ” for the AVF group and the “ date when eGFR was closest to the matched patient ’ s eGFR at AVF creation ” for the PD group. Crude and predicted eGFR decline in AVF and PD groups were compared before and after time zero using mixed-effect linear regressions. Results In total, 61 pairs were matched. Crude annual eGFR decline before AVF creation/time zero was 2 4.1 ml/ min per m 2 per year in the AVF group versus 2 5.3 ml/min per m 2 per year in the PD group ( P 5 0.75) and after time zero, 2 2.5 ml/min per m 2 per year in the AVF group versus 2 4.5 ml/min per m 2 per year in the PD group ( P 5 0.02). The predicted annual decline decreased from 2 5.1 ml/min per m 2 per year in the AVF group before AVF creation to 2 2.8 ml/min per m 2 per year after ( P , 0.01), whereas there was no difference in the PD group ( 2 5.5 versus 2 5.1 ml/min per m 2 per year respectively, P 5 0.41). Conclusions In this matched study, AVF creation was associated with a deceleration of kidney function decline compared with a control PD-oriented group. Prospective studies are needed to assess the potential mechanisms between vascular access creation and eGFR slope attenuation. KIDNEY360