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A study on international differences regarding location and use of arteriovenous fistulas (AVF) and arteriovenous grafts (AVG) in hemodialysis (HD) necessitates an international team of authors.

In this case, researchers from the US, UK, Japan and Turkey joined forces (Pisoni RL et al, International Differences in the Location and Use of Arteriovenous Accesses Created for Hemodialysis: Results From the Dialysis Outcomes and Practice Patterns Study (DOPPS); Am J Kidney Dis. 2017; doi: 10.1053/j.ajkd.2017.09.012). These authors investigated what was determined to be “substantial” international variation regarding AVF and AVG use and AVF maturation time and location. 

The prospective cohort study included HD patients who took part in the prospective Dialysis Outcomes and Practice Patterns Study (DOPPS) from the United States, Japan, Europe and Australia and New Zealand (ANZ). This involved 3,850 patients receiving 4,247 new AVFs and 842 patients receiving 1,129 new AVGs. AVF location trends were based on 38,868 AVFs recorded in DOPPS cross-sections 1 to 5 (2009-2015). Primary outcomes were AVF location, successful AVF/AVG use (30 days of continuous use) and maturation (time-to-first successful AVF/AVG use). 

  • Percentage of AVFs located in the lower arm: This was consistently 93% in Japan and 65 to 77% in Europe/ANZ. By contrast, in the United States this value decreased from 70% to 32% within the observed six-year time frame.

  • Successful AVF use: 87% in Japan, 67% in Europe/ANZ, 64% in the United States

    • Successful AVF use was greater for upper- versus lower-arm AVFs in the United States, with little difference in Europe/ANZ and the opposite pattern in Japan. Here, successful AVF use was lower for upper- versus lower-arm AVFs.

  • Successful AVG use: 86% in Japan, 75% in Europe/ANZ, and 78% in the US, respectively.

  • Median time until

    • first successful AVF use: ten days in Japan, 46 days in Europe/ANZ, and 82 days in the US;

    • first successful AVG use: six, 24, and 29 days, respectively. 

There are large international differences regarding AVF location, predictors of AVF location, successful use of AVFs, and time to first AVF/AVG use. These results therefore challenge what some clinicians would consider “best practice”, comment the authors.

Link to the study: