DOES THE CREATION OF ARTERIOVENOUS FISTULA IN PREDIALYSIS CKD PATIENTS LEAD TO DECREASE IN THE RATE OF DECLINE OF GFR : A META-ANALYSIS

7 Feb 2025 12 a.m. 12 a.m.
WCN25-AB-2368, Poster Board= FRI-392

Introduction:

Premptive placement of arteriovenous fistula(AVF) in late stage chronic kidney disease(CKD) patients is being advocated by all the major guidelines. Recent studies have suggested that premptive AVF has a beneficial effect on glomerular filtration rate(GFR) also. We did this meta-analysis with the aim to assess the evidence that whether AVF in predialysis CKD patients slows down the rate of decline of GFR or not.This is the first meta analysis being done on this topic.

Methods:

We conducted a literature search to retrieve all published studies related to the effect of AVF on the rate of decline of GFR. Article search was conducted from inception up till May 2021.

 Screening of studies and data extraction was done according to the PRISMA guidelines.

 PICO question

Patient:  Pre-dialysis CKD patients undergoing AV fistula surgery

Intervention:  AVF creation in the pre-dialysis phase of CKD

Outcome:  Change in GFR trajectory before and after AVF creation. 

Change in standardized mean difference with 95% CI of the rate of decline of eGFR between prior to AV fistula creation and after the AV fistula creation was the effect measure of the main outcome.

 Methodological quality assessment of studies was done using We used the NIH assessment  tool. Extracted data from the six studies was pooled and analysed.

Results:

Screening process and the studies identified according to PRISMA guidelines,2020Forest plot for the assessment of difference in the rates of decline of eGFR before and after creation of AVF

Risk of bias assessment using NIH quality assessment tools for before-after studies

Six studies involving 3871 patients were included . Evidence for statistically significant decrease in the rate of decline of eGFR after AVF creation compared to prior status (SMD -1.58, 95% CI -3.08 to -0.07, P<0.001) was observed.  Significant heterogeneity in the pooled analysis (I2 = 99.7%) were observed but all the effects were in the same direction. The overall risk of bias for the included studies was high. Certainty of evidence was low.

Conclusions:

Creation of AVF seems to retard the rate of deterioration of renal function with low level of certainty. Additional high quality studies are needed to clarify the above finding.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.