From tunneled dialysis catheter to arteriovenous fistula: Maturation and reintervention outcomes in distal versus proximal cephalic arteriovenous fistulas

Objective In hemodialysis (HD) patients with a tunneled dialysis catheter (TDC), choosing the right arteriovenous fistula (AVF) at first attempt is key to minimizing TDC duration. Proximal (brachiocephalic) AVFs are often favored over distal (radio/ulnar-cephalic) due to presumed better outcomes, though data are limited. We compared maturation, reintervention, and TDC duration between proximal and distal cephalic AVFs. Methods A multi-institutional retrospective review of patients with a TDC and no prior AV access who underwent a cephalic AVF from 2014-2019 at five safety net hospitals within the Los Angeles County health system was conducted. The primary endpoint was AVF maturation. Secondary outcomes were reintervention rate, types of interventions needed to achieve maturation and time to maturation. Patients were stratified into Distal and Proximal. Bivariate analysis evaluated the outcomes of interest. Results Of the 645 cephalic AVFs, 190 (29.5%) were Distal and 455 (70.5%) were Proximal. Compared to Proximal, Distal had lower overall rates of maturation (77.4 vs 87.9%, P