Association between prior peritoneal dialysis and arteriovenous fistula maturation and patency in patients with end-stage renal disease: a comparative study

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Patients with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) often require transition to hemodialysis (HD), yet the association between prior PD and arteriovenous fistula (AVF) outcomes remains unclear. This study aimed to compare AVF maturation and patency between patients with and without prior PD. This single-center, retrospective, comparative study included patients with ESRD who underwent their first AVF creation between January 2018 and December 2022. AVF maturation, patency, and related parameters were compared between patients with and without prior PD. A total of 571 patients were included for analysis and 82 patients (14.4%) had a history of PD. Patients who had PD had significantly lower rates of overall successful (87.8% vs. 94.1%, p = 0.037) and unassisted AVF maturation (65.9% vs. 82.4%, p = 0.001) compared with non-PD patients, as well as lower one-year primary (60.2% vs. 70.7%, p = 0.046) and cumulative patency rates (86.5% vs. 93.4%, p = 0.027). In multivariable analyses, prior PD was independently associated with a lower likelihood of unassisted AVF maturation (odds ratio [OR] = 0.442, 95% CI = 0.219–0.891, p = 0.022) and a higher risk of one-year cumulative patency failure (hazard ratio [HR] = 2.759, 95% CI 1.343–5.667, p = 0.006). Prior PD may be associated with lower AVF maturation and patency rates. Early vascular access planning might be recommended for PD patients approaching technique failure. Further prospective studies are needed to validate these findings.

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