SuO007
INFLUENCE OF ARTERIO VENOUS ACCESS PLACEMENT ON RENAL FUNCTION DECLINE

INTRODUCTION AND AIMS: It has been proposed that placement of an Arterio Venous Access, (AVA) reduce renal function decline, but convincing evidence is lacking. This study aimed to investigate the influence of AVA placement on GFR decline as compared to placement of a peritoneal dialysis catheter, (PDC) at a similar time point.

METHODS: All pre-dialytic patients ≥18 years in the Stockholm County, Sweden who underwent surgery for an AVA or PDC between March 1, 2006 and September 30, 2012 were included. Information on diabetes and cardiovascular disease on or before surgery date was obtained from clinical records. Prescribed medication was ascertained by the National Registry for Dispensed drugs. Information on laboratory measures of interest (eGFR_CKD-EPI, hemoglobin, potassium, albumin, proteinuria, phosphate, and calcium) was collected 100 days before and after surgery. Patients were followed until start of dialysis, death or for 100 days, whichever came first. The primary outcome was the difference in eGFR decline after surgery in those with AVA compared with PDC (intention to treat). eGFR decline was estimated through linear mixed models with random intercept and slope before and after surgery. The association between type of surgery (AVA/PDC) and eGFR decline was studied in a linear regression model adjusting for age, sex, eGFR at the time of surgery and decline before surgery, medication, and plasma albumin. Sensitivity analyses were performed (propensity score matching, different model specifications, and restricted analyses).

RESULTS: There were 435 patients with AVA placement and 309 with PDC as their first line of treatment. The AVA patients were slightly older (64.5 versus 62.6 years), and more often men (63.5% versus 62.5%). Compared with PDC, patients with AVA had more cardiovascular disease and diabetes, but lower use of ESA and ACE/ARB. The eGFR at the time of surgery was higher in patients who received an AVA (8.1 versus 7.0 ml/min/1.73m²) and they had a less rapid decline before surgery (-5.6 compared with -6.7 ml/min/1.73m²/year for PDC). Both patients with AVA and PDC had slower decline in eGFR after than prior to surgery. There was no difference in the eGFR decline after surgery in AVA patients compared with PDC patients (AVA progressed -1.14 (-2.38; 0.10) ml/min/1.73m²/year faster after surgery compared with PDC). Propensity score matched analysis showed no major difference compared with the primary analysis (adjusted eGFR decline was -2.33 (-8.45; 1.46) ml/min/1.73m²/year faster in AVA patients).

CONCLUSIONS: In summary, this study shows no influence of Arterio Venous access compared to PD catheter placement on the decline of eGFR. The progression of renal function was not associated with the placement of an AV access. Thus, the need for dialysis remains the main determinant for timing of AV access placement.