Patency and maturation rates after forearm arteriovenous fistulas: systematic review with meta-analysis

The growing burden of chronic kidney disease has significantly increased the demand for hemodialysis, with reliable vascular access being vital for treatment success. Although the radiocephalic arteriovenous fistula (AVF) remains the first option as a long term hemodialysis access, challenges related to aging patient population and prevalence of comorbidities may compromise maturation and durability. Therefore, this systematic review with meta-analysis aims to determine the patency and maturation rates of radiocephalic AVF, focusing on how different patient characteristics and surgical methodologies impact these rates. Pubmed, Web of Science and Cochrane were systematically searched for studies assessing patency and maturation rates of radiocephalic AVF. Primary and secondary endpoints were pooled by random-effects meta-analysis, with sources of heterogeneity being explored by meta-regression. Thirty-six cohort studies were selected, 15 of which were prospective. The meta analytical incidence of primary patency rates at 30 days, and at 1, 2, and 3 years after fistula creation was 84.18%, 68.43%, 59.86% and 55.10%, respectively. Additionally, the meta-analytical incidence of maturation failure, infection, aneurysm degeneration, early-thrombosis and reintervention rates was 24.7%, 3.9%, 3.6%, 6.3% and 29.4%, respectively. All the variables previously referred had high levels of heterogeneity associated. Furthermore, meta-regression analysis identified previous vascular access construction and latero-lateral anastomosis as factors associated with higher maturation failure rates. The significant heterogeneity observed in the endpoints evaluated highlight the complexity of radiocephalic AVF management. These findings underline the need for standardized clinical practices and further large-scale studies to identify factors influencing radiocephalic AVF outcomes.