Access blood flow and the risk of complications in mature forearm and upper arm arteriovenous fistulas.

Background/aims: Optimization of vascular access use in the 'fistula first' era requires comprehension of its clinical behavior. Little is known about mature arteriovenous fistula (AVF) performance and the role of fistula location. Widely used access flow (Qa) was used to analyze complication risks and functionality after first hemodialysis use.

Methods: 178 Mature AVFs were analyzed. Complication was defined as permanent failure or >or=1 intervention. Factors associated with complications and mean Qa were determined using Cox proportional-hazards and linear regression models.

Results: Baseline Qa was significantly lower in complicated versus uncomplicated forearm and upper arm AVFs. In complicated forearm AVFs, preoperative arterial diameter was smaller while the risk of complications was graded per 100 ml/min baseline Qa increase. Diabetics had an increased risk of upper arm AVF complications. In uncomplicated forearm AVFs, diabetes was related to lower mean Qa, and BMI to higher Qa.

Conclusions: In mature AVFs, baseline Qa depends on fistula location and is related to the risk of complications in a graded manner.