Scoring predictor for successful of arteriovenous fistulas as vascular access in hemodialysis patients: PAVAS score

Introduction: The use of vascular access (AV-fistula) for long-term hemodialysis is still served as the primary choice. The fact that there is still a high rate of failure of arteriovenous fistulas procedure is one of the obstacles in the treatment of chronic kidney disease problems. This study aims to assess the risk factors for AV-fistula or AV-shunt failure and develop a risk scoring system for the failure of the AV-fistula procedure in patients with chronic kidney disease. Methods: This study is a prospective study conducted at Dr. Soetomo Hospital, Surabaya, Indonesia. The analysis focuses on the risk factors for AV-fistula failure and performs a scoring order using multiple logistic regression methods. Results: Based on this study, three variables were found to have significant values in determining the risk of AV-fistula failure scoring, namely local arterial condition (p<0.1), local venous condition (p<0.1), and arterial diameter (p<0.1). The scoring system for normal arteries, normal veins, and artery diameter >1.8 mm was scored 1. Scoring for veins and arteries with a history of puncture was 1. Arteries with stiff sensation with weak pulses and veins with a history of intravenous catheters scored 2. Conclusion: The use of scoring based on parameters of arterial diameter, local venous condition, and local arterial condition becomes a scoring system for predictors of the risk of failure of the AV-shunt procedure, with three scoring categories, namely low risk (score 0-1), medium risk (score 2 -3), and high risk (score 4-5). This study is only a preliminary study for arteriovenous fistula scoring (PAVAS Score) due to the limited sample size so that a large-scale follow-up study is needed to assess the validity of the proposed PAVAS score.