Arteriovenous fistula in predialysis chronic kidney disease patients and rate of decline of glomerular filtration rate

Purpose: To quantify the evidence for the role of arteriovenous fistula (AVF) in predialysis CKD patients for the rate of decline of glomerular filtration rate (GFR). Background: Pre-emptive placement of arteriovenous fistula (AVF) in late-stage chronic kidney disease (CKD) patients is being advocated by all the major guidelines. Recent studies have suggested that pre-emptive AVF has a beneficial effect on glomerular filtration rate (GFR) also. Methods: We conducted a literature search to retrieve all published studies related to the effect of AVF on the rate of decline of GFR using the electronic databases Google Scholar, PubMed, Central, Cochrane Library, clinialtrial.gov. Screening of studies and data extraction were done according to the PRISMA guidelines. We used the NIH assessment tool for the methodological quality assessment of the included studies. Extracted data from the six studies were pooled and analyzed. Results: Six studies involving 3871 patients reported the effect of AVF creation on the rate of decline of GFR in late CKD patients. Evidence for statistically significant decline of eGFR after AVF creation compared to prior status (SMD -1.57, 95% CI -3.08 to -0.07, p < 0.001) was observed. Conclusion: Our meta-analysis observed preliminary evidence that the creation of AVF might have a potential added benefit in terms of estimated GFR improvement, though to a very small extent with a low level of certainty. More scientific data with high-quality studies are needed to substantiate this finding.