Arteriovenous fistula thrombosis is associated with increased all-cause and cardiovascular mortality in haemodialysis patients from the AURORA trial

Girerd, S. et al. (2020) Arteriovenous fistula thrombosis is associated with increased all-cause and cardiovascular mortality in haemodialysis patients from the AURORA trial. Clinical Kidney Journal, 13(1), pp. 116-122. (doi: 10.1093/ckj/sfz048) (PMID:32082562) (PMCID:PMC7025348)

Abstract

Background: The impact of arteriovenous fistula (AVF) or graft (AVG) thrombosis on mortality has been sparsely studied. This study investigated the association between AVF/AVG thrombosis and all-cause and cardiovascular mortality. Methods: The data from 2439 patients with AVF or AVG undergoing maintenance haemodialysis (HD) included in the A Study to Evaluate the Use of Rosuvastatin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events trial (AURORA) were analysed using a time-dependent Cox model. The incidence of vascular access (VA) thrombosis was a pre-specified secondary outcome. Results: During follow-up, 278 AVF and 94 AVG thromboses were documented. VA was restored at 22 ± 64 days after thrombosis (27 patients had no restoration with subsequent permanent central catheter). In multivariable survival analysis adjusted for potential confounders, the occurrence of AVF/AVG thrombosis was associated with increased early and late all-cause mortality, with a more pronounced association with early all-cause mortality {hazard ratio [HR] < 90 days 2.70 [95% confidence interval (CI) 1.83–3.97], P < 0.001; HR > 90 days 1.47 [1.20–1.80], P < 0.001}. In addition, the occurrence of AVF thrombosis was significantly associated with higher all-cause mortality, whether VA was restored within 7 days [HR 1.34 (95% CI 1.02–1.75), P = 0.036] or later than 7 days [HR 1.81 (95% CI 1.29–2.53), P = 0.001]. Conclusions: AVF/AVG thrombosis should be considered as a major clinical event since it is strongly associated with increased mortality in patients on maintenance HD, especially in the first 90 days after the event and when access restoration occurs >7 days after thrombosis. Clinicians should pay particular attention to the timing of VA restoration and the management of these patients during this high-risk period. The potential benefit of targeting overall patient risk with more aggressive treatment after AVF/AVG restoration should be further explored.

• Item Type: Articles
• Additional Information: P.R., N.G. and F.Z. are supported by a public grant overseen by the French National Research Agency (ANR) as part of the second ‘Investissements d’Avenir’ programme (reference ANR-15-RHU-0004).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jardine, Professor Alan
• Authors: Girerd, S., Girerd, N., Frimat, L., Holdaas, H., Jardine, A. G., Schmieder, R. E., Fellström, B., Settembre, N., Malikov, S., Rossignol, P., and Zannad, F.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Clinical Kidney Journal
• Publisher: Oxford University Press
• ISSN: 2048-8505
• ISSN (Online): 2048-8513
• Published Online: 11 May 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Clinical Kidney Journal 13(1): 116-122
• Publisher Policy: Reproduced under a Creative Commons license