Factors associated with arteriovenous fistula failure among patients with stage 5 chronic kidney disease receiving hemodialysis: A retrospective study in Indonesia

Abstract

Arteriovenous fistula (AVF) is the preferred vascular access for maintenance hemodialysis; however, failure to achieve or maintain functional access remains a major clinical challenge. The aim of this study was to identify factors associated with AVF failure among patients with stage 5 chronic kidney disease undergoing hemodialysis. A retrospective observational study was conducted at the Hemodialysis Unit of Saiful Anwar Hospital, Malang, Indonesia, between November 2021 and January 2022. Demographic and clinical data were extracted from medical records. Bivariate analyses were performed to identify potential associated factors, and variables with p<0.25 were subsequently entered into a multivariable logistic regression model. Overall, 32.0% of patients experienced AVF failure, whereas 68.0% achieved successful AVF use. In the bivariate analyses, sex, education level, previous vascular access type, history of AVF repair, interval between chronic kidney disease diagnosis and AV shunt placement, time to AV shunt usability, duration of AV shunt use, post-intervention AV shunt usability, and diabetes mellitus were associated with AVF failure. After multivariable adjustment, only previous vascular access type remained independently associated with AVF failure. Previous AV shunt use was associated with substantially lower odds of AVF failure (adjusted odds ratio: 0.0046; 95% confidence interval: 0.00002–0.110; p=0.009). Other demographic and clinical factors were no longer statistically significant after adjustment. These findings suggest that previous vascular access type was independently associated with AVF failure in hemodialysis patients, highlighting the importance of optimizing vascular access selection to improve AVF outcomes. Prospective multicenter studies with larger populations are warranted to confirm this association and clarify its clinical relevance.