Hemodialysis Fistula Maturation Consortium

In patients undergoing hemodialysis for end-stage renal disease, a large number of fistulas fail to mature adequately to support the hemodialysis blood circuit and cannot be used for dialysis. Currently, hemodialysis access using fistulas is hindered by a lack of predictors of and therapies for arteriovenous fistula (AVF) failure. The Hemodialysis Fistula Maturation Study was a prospective, multicenter observational study that was established by the Hemodialysis Fistula Maturation Consortium (HFMC) to identify the clinical and biological factors associated with AVF maturation outcomes. The primary objectives of the study included improving prediction of AVF maturation and exploring the mechanism of AVF failure by examining the relationship between clinical usability and anatomy, biology, clinical attributes, and processes of care.

The study enrolled patients nearing or with end-stage renal disease who are undergoing AVF creation for hemodialysis. Data were collected pre-operatively, peri-operatively, and post-operatively. Medical history, demographics, and physical examination information were collected prior to surgery at baseline. Participants undergone preoperative ultrasound arterial and venous mapping, flow-mediated and nitroglycerin-mediated brachial artery dilation, arterial pulse wave velocity, and venous distensibility; additionally, ultrasounds will be administered at 1 day, 2 weeks, 6 weeks, and prior to fistula intervention and initial cannulation. Information were collected peri-operatively on surgical personnel, surgical procedures, and clinical observations. Outcome data on AVF usability and other dialysis-related data were collected post-operatively. In addition to these measurements, tissue and blood specimens were collected for analyses of histology, morphometry, immunohistochemistry, and gene expression.