THE PREVALENCE OF POOR MATURATION OF ARTERIOVENOUS FISTULA IN HEMODIALYSIS PATIENTS: A META-ANALYSIS

Sharmarke Abdullahi Nor#, Li Song#, Wei Dong, Yuanhan Chen, Zi-lin Quan, Yan Yin, Zhiming Ye and Xin-Ling Liang*

ABSTRACT

Background: Poor arteriovenous fistula (AVF) maturation is a significant challenge that restricts the clinical utility of AVF in patients undergoing hemodialysis. Objective: To address the gap in knowledge regarding the current practices in the management of patients with CKD and AVF maturation. There exists a regional variation that can result in adverse outcomes and no comparative data to guide future clinical research. Methods: We performed a systematic search of the electronic databases of PubMed, Embase, MEDLINE, and Google Scholar till October 21, 2023, using the keywords “Maturation,” “Arteriovenous Fistula,” “AVF,” and “Dialysis.” We adopted this approach to optimize study retrieval, which included a summary of published English-language articles enrolling human subjects. Results: Our first search retrieved a total of 778 citations, of which 30 eligible studies were identified using deduplication, screening, and full-text review. These studies included a total of 7756 patients (95% CI: 24%-26%), and information on the globally pooled AVF poor maturation rate was 25% (95% CI: 24%-26%). Regional prevalence was 20% (95% CI: 16%–24%) in Asia; 28% (95% CI: 22%–34%) in Europe; and 27% (95% CI: 20%–34%) in the Americas. The pooled prevalence for males was 23% (95% CI: 19%-26%), whereas for females the pooled prevalence was 25% (95% CI: 21%-31%). Conclusion: The overall incidence rates of poor AVF maturation in hemodialysis patients vary by region, being higher in Europe and the Americas than in Asia, and do not depend on sex. It highlights the necessity of taking geographic regions into account for a clinical approach to AVF maturation and acts as a frame of reference for future studies.

Keywords: Haemodialysis, poor arteriovenous fistula maturation, meta-analysis.