Arteriovenous (AV) fistula non-maturation is currently a huge clinical problem and a major cause of morbidity and increased costs in the hemodialysis population. Although AV fistulae are the preferred mode of dialysis access they have a very high incidence of maturation failure due to a juxta-anastomotic venous stenosis. This results in multiple endovascular and surgical procedures, together with prolonged catheter dependence (the latter often resulting in sepsis). Despite the magnitude of the clinical problem, however, we currently nave no way of predicting which patients are at high risk of AV fistula non-maturation. The central objective of the current proposal is to identify predictive markers for AV fistula success or failure. In the longer term, we believe that the mechanistic information obtained from this work, will allow for the development of novel therapies to enhance AV fistula maturation. We plan to address our central objective through a prospective, cohort, observational study which will enroll upto 1200 patients who require a new AV fistula over 6-8 clinical sites.
In Specific Aim 1, we will assess the impact of clinical markers such as demographics, co-morbidities, vessel size and previous vascular access history on AV fistula maturation and patency.
In Specific Aim 2, we will study the relationship between hemodynamic markers such as blood flow, physical examination, the angle of the AV anastomosis and hemodynamic shear stress on AV fistula maturation. Finally, in Specific Aim 3, we will examine the role of biological markers such as oxidative stress and endothelial function on AV fistula maturation. Logistic regression analyses will be performed to identify both individual predictors and groups of predictors for AV fistula non-maturation. We will also use this data to develop clinician friendly """"""""risk scores"""""""" for use both prior to surgery and after AV fistula placement. We believe that the current proposal will allow us to stratify patients requiring a new dialysis access into high and low risk groups. Patients in the high risk group would then either be targeted for aggressive follow up and intervention or considered for alternate forms of dialysis access (PTFE grafts). Looking to the future, we also hope that the mechanistic information obtained from this study will allow us to develop novel therapeutic interventions to enhance AV fistula maturation. This could reduce the huge clinical and economic burden currently associated with AV fistula non-maturation. Relevance to Public Health: A better understanding of the factors responsible for AV fistula stenosis could allow us to develop better ways of predicting, monitoring and treating all forms of vascular stenosis including coronary, carotid and peripheral vascular disease.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project--Cooperative Agreements (U01)
Project #
5U01DK082218-04
Application #
8137098
Study Section
Special Emphasis Panel (ZDK1-GRB-6 (M1))
Program Officer
Kusek, John W
Project Start
2008-09-10
Project End
2013-05-31
Budget Start
2011-06-01
Budget End
2012-05-31
Support Year
4
Fiscal Year
2011
Total Cost
$344,881
Indirect Cost
Name
University of Cincinnati
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
041064767
City
Cincinnati
State
OH
Country
United States
Zip Code
45221
Allon, Michael; Greene, Tom; Dember, Laura M et al. (2016) Association between Preoperative Vascular Function and Postoperative Arteriovenous Fistula Development. J Am Soc Nephrol 27:3788-3795
Farber, Alik; Imrey, Peter B; Huber, Thomas S et al. (2016) Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study. J Vasc Surg 63:163-70.e6
Robbin, Michelle L; Greene, Tom; Cheung, Alfred K et al. (2016) Arteriovenous Fistula Development in the First 6 Weeks after Creation. Radiology 279:620-9
Roy-Chaudhury, Prabir; Kruska, Lindsay (2015) Future directions for vascular access for hemodialysis. Semin Dial 28:107-13
Roy-Chaudhury, Prabir; Verma, Ashish (2015) Improving patient safety in vascular access: a role for individualization and patient preferences. Contrib Nephrol 184:136-42
Lee, Timmy; Somarathna, Maheshika; Hura, Arjan et al. (2014) Natural history of venous morphologic changes in dialysis access stenosis. J Vasc Access 15:298-305
Dember, Laura M; Imrey, Peter B; Beck, Gerald J et al. (2014) Objectives and design of the hemodialysis fistula maturation study. Am J Kidney Dis 63:104-12
Chan, Jenq-Shyong; Campos, Begoña; Wang, Yang et al. (2014) Proliferation patterns in a pig model of AV fistula stenosis: can we translate biology into novel therapies? Semin Dial 27:626-32
Lee, Timmy; Tindni, Arshdeep; Roy-Chaudhury, Prabir (2013) Improved cumulative survival in fistulas requiring surgical interventions to promote fistula maturation compared with endovascular interventions. Semin Dial 26:85-9
Roy-Chaudhury, Prabir; Lee, Timmy C; Munda, Rino (2013) Predicting dialysis vascular access blood flow and diameter: too much, too little, or just right. Kidney Int 84:1076-8

Showing the most recent 10 out of 24 publications