Ann Surg Treat Res.  2020 Jan;98(1):44-50. 10.4174/astr.2020.98.1.44.

Development and validation of a clinical score to predict 1-year survival of arteriovenous fistula access: a diagnostic study

  • 1Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.


To develop and validate a clinical scoring model to predict 1-year access survival among end-stage renal disease (ESRD) patients who received a new arteriovenous fistula (AVF).
The data of 195 ESRD patients in the development cohort who underwent first-time AVF creation between January 2009 and June 2013 and who had successful cannulation for dialysis use were reviewed. The clinical features that were significantly associated with 1-year AVF survival were incorporated into a clinical scoring model. The validity of this clinical score was then tested in a validation cohort of 204 ESRD patients who received a new AVF between July 2013 and December 2017.
Of the 195 patients in the development cohort, 168 patients (86.2%) had a well-functioning AVF at 1 year. Absence of diabetes mellitus, no previous history of central venous catheter insertion, and absence of intervention performed to achieve access maturation were positively associated with 1-year AVF survival. These 3 factors were incorporated into a clinical scoring model, which ranged from 0 to 4 points. For a cutoff score of ≥3, the sensitivity, specificity and area under the receiver operating characteristic curve to predict 1-year AVF survival were 81.5%, 70.4%, and 0.760, respectively. The predictive performance of the clinical score was confirmed in the validation cohort, with a sensitivity of 76.1%, a specificity of 64.4% and an area under the curve of 0.703.
The scoring model using clinical data yielded acceptable performance in predicting 1-year access survival among patients receiving a new AVF.


Arteriovenous fistula; End-stage renal disease; Renal dialysis; Treatment outcome

MeSH Terms

Arteriovenous Fistula*
Central Venous Catheters
Cohort Studies
Diabetes Mellitus
Kidney Failure, Chronic
Renal Dialysis
ROC Curve
Sensitivity and Specificity
Treatment Outcome


  • Fig. 1 STARD (Standards for the Reporting of Diagnostic Accuracy) flow diagrams of the development and validation cohorts. AVF, arteriovenous fistula.

  • Fig. 2 Receiver operating characteristic (ROC) curve of the clinical score for the prediction of access survival at 1 year among patients undergoing first-time arteriovenous fistula creation in the development cohort. Each number on the line represents a cutoff score.


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