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.


1. Santoro D, Benedetto F, Mondello P, Pipito N, Barilla D, Spinelli F, et al. Vascular access for hemodialysis: current perspectives. Int J Nephrol Renovasc Dis. 2014; 7:281–294.
2. Vascular Access Work Group. Clinical practice guidelines for vascular access. Am J Kidney Dis. 2006; 48:Suppl 1. S248–S273.
3. III. NKF-K/DOQI Clinical Practice Guidelines for Vascular Access: update 2000. Am J Kidney Dis. 2001; 37:1 Suppl 1. S137–S181.
4. Bashar K, Conlon PJ, Kheirelseid EA, Aherne T, Walsh SR, Leahy A. Arteriovenous fistula in dialysis patients: factors implicated in early and late AVF maturation failure. Surgeon. 2016; 14:294–300.
5. Chisci E, Harris LM, Menici F, Frosini P, Romano E, Troisi N, et al. Outcomes of three types of native arteriovenous fistula in a single center. J Vasc Access. 2017; 18:379–383.
6. Kim SM, Han Y, Kwon H, Hong HS, Choi JY, Park H, et al. Impact of a preoperative evaluation on the outcomes of an arteriovenous fistula. Ann Surg Treat Res. 2016; 90:224–230.
7. Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX, et al. Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis. 2014; 63:464–478.
8. Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking E, Gillespie B, et al. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int. 2002; 61:305–316.
9. Lee T, Ullah A, Allon M, Succop P, El-Khatib M, Munda R, et al. Decreased cumulative access survival in arteriovenous fistulas requiring interventions to promote maturation. Clin J Am Soc Nephrol. 2011; 6:575–581.
10. Radoui A, Lyoussfi Z, Haddiya I, Skalli Z, El Idrissi R, Rhou H, et al. Survival of the first arteriovenous fistula in 96 patients on chronic hemodialysis. Ann Vasc Surg. 2011; 25:630–633.
11. Harms JC, Rangarajan S, Young CJ, Barker-Finkel J, Allon M. Outcomes of arteriovenous fistulas and grafts with or without intervention before successful use. J Vasc Surg. 2016; 64:155–162.
12. Dias BH, Olakkengil SA. Predictors of patency following fistulography and percutaneous interventions in the treatment of nonfunctioning native vascular access. Indian J Vasc Endovasc Surg. 2015; 2:7–11.
13. Gh K, Mhs M, H R, M D, L H, M N. Primary patency rate of native AV fistula: long term follow up. Int J Clin Exp Med. 2012; 5:173–178.
14. Lok CE, Allon M, Moist L, Oliver MJ, Shah H, Zimmerman D. Risk equation determining unsuccessful cannulation events and failure to maturation in arteriovenous fistulas (REDUCE FTM I). J Am Soc Nephrol. 2006; 17:3204–3212.
15. Masengu A, Maxwell AP, Hanko JB. Investigating clinical predictors of arteriovenous fistula functional patency in a European cohort. Clin Kidney J. 2016; 9:142–147.
16. Twine CP, Haidermota M, Woolgar JD, Gibbons CP, Davies CG. A scoring system (DISTAL) for predicting failure of snuffbox arteriovenous fistulas. Eur J Vasc Endovasc Surg. 2012; 44:88–91.
17. Bosanquet DC, Rubasingham J, Imam M, Woolgar JD, Davies CG. Predicting outcomes in native AV forearm radio-cephalic fistulae; the CAVeA2T2 scoring system. J Vasc Access. 2015; 16:19–25.
18. Martinez LI, Esteve V, Yeste M, Artigas V, Llagostera S. Clinical utility of a new predicting score for radiocephalic arteriovenous fistula survival. Ann Vasc Surg. 2017; 41:56–61.
19. Bashar K, Zafar A, Elsheikh S, Healy DA, Clarke-Moloney M, Casserly L, et al. Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease. PLoS One. 2015; 10:e0119958.
20. Sullivan LM, Massaro JM, D'Agostino RB Sr. Presentation of multivariate data for clinical use: The Framingham Study risk score functions. Stat Med. 2004; 23:1631–1660.
21. Jennings WC, Kindred MG, Broughan TA. Creating radiocephalic arteriovenous fistulas: technical and functional success. J Am Coll Surg. 2009; 208:419–425.
22. Lee T, Mokrzycki M, Moist L, Maya I, Vazquez M, Lok CE, et al. Standardized definitions for hemodialysis vascular access. Semin Dial. 2011; 24:515–524.
23. Aragoncillo I, Abad S, Caldes S, Amezquita Y, Vega A, Cirugeda A, et al. Adding access blood flow surveillance reduces thrombosis and improves arteriovenous fistula patency: a randomized controlled trial. J Vasc Access. 2017; 18:352–358.
Full Text Links
  • ASTR
export Copy
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: