■ 学会名
the 70th Annual Meeting of the Japanese Society for Dialysis Therapy (JSDT 2025)

■ 発表日
2025/06/27

■ 筆頭演者
Yoshihisa Miyamoto
Department of Real-world Evidence Graduate School of Medicine The University of Tokyo

■ 共同演者
Akira Okada², Yusuke Sasabuchi¹, Yoshifumi Hamasaki³, Motonobu Nakamura³, Hideo Yasunaga⁴
1) Department of Real-world Evidence, Graduate School of Medicine, The University of Tokyo
2) Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo
3) Division of Nephrology and Endocrinology, The University of Tokyo Hospital
4) Department of Clinical Epidemiology and Health Economics, Graduate School of Medicine, The University of Tokyo

■ 発表形態
Oral

■ 要旨　
Purpose: We aimed to investigate association between time from creation of
arteriovenous fistula (AVF) to hemodialysis (HD) initiation and subsequent patency in a hemodialysis-naive population.
Method: Using the DeSC database, we identified patients with a newly created AVF
without prior hemodialysis within 90 days. Loss of primary unassisted patency was
defined as requirement of interventions such as angioplasty and thrombectomy, or the need for new access (AVF, arteriovenous graft, arterial superficialization, or cuffed vascular access catheter). Loss of secondary patency was defined solely by the need for new access. Incidence of the first and recurrent events after hemodialysis initiation was reported. Association between time from AVF creation to HD initiation and the events was assessed using Cox, Fine-Gray and PWP (Prentice, Williams, and Peterson) total time models after adjustment of patient’s characteristics.
Results: We analyzed 10,566 patients (mean age 75.7 years, 31.1% female). During a median follow-up of 517 days, 18,461 primary unassisted patency losses (101 events/100 person-years) and 1,873 secondary patency losses (10.2 events/100 person-years) were observed. The incidence of the first event was 50.8 and 8.6 events/100 person-years for primary and secondary patency loss, respectively. Longer time from AVF creation to HD initiation was associated with lower risks of both incident and recurrent losses of primary and secondary patency.
Discussion: This real-world database analysis supported the association between
a longer interval from AVF creation to HD initiation and lower needs for interventions.
Conclusion: Creating AVFs earlier before starting HD may reduce the need for
interventions.