Factors Influencing Maturation Time of Native Arteriovenous Fistulas

Background To determine the factors influencing the maturation time of native arteriovenous fistulas. Methods A retrospective review was performed of hemodialysis patients from a single university-associated dialysis center from 2004 to 2009. Demographics, comorbidities, and insurance status were recorded. Maturation time was defined as the time from access creation until the access was able to be used regularly for hemodialysis for a period of 2 weeks. Results A total of 249 patients were identified during the study period who had an arteriovenous fistula created that successfully matured; 104 (42%) patients were women and 145 (58%) were men. Most of the patients were Hispanic (82%). Ninety-seven (39%) of the patients had Medicaid-type insurance and 133 (53%) had Medicare. The mean age was 51 years, and 190 (76%) of the patients had diabetes. The overall mean maturation time was 79 days. Women had a significantly longer time to fistula maturation than males (91.9 days vs. 70.5 days, P = 0.0028). Diabetics also had a significantly longer maturation time than nondiabetics (92.5 days vs. 75.4 days, P = 0.0004). Age did not have an effect on maturation time. On multivariable analysis, sex remained significant ( P = 0.007), however, diabetes lost its significance. Conclusions In this predominantly Hispanic hemodialysis population, women require longer fistula maturation times than men. The exact reasons for this are unknown based on this data. More study is required to determine the etiology of this gender discrepancy.