Development and validation of a prediction model for maturation failure of autogenous arteriovenous fistula based on duplex ultrasound hemodynamic parameters at 2 weeks after surgery_West China Medical Journal

Authors：

CAO Wen , HU Xiu , QING Wei , LIU Minglin , FENG Yu , ZHANG Li , XU Xiaoling ,  SONG Bin

Department of Nephrology, Deyang People’s Hospital, Deyang, Sichuan 618000, P. R. China;

Corresponding?author：

SONG Bin, Email: sb8052@126.com

Keywords：

Autogenous arteriovenous fistula; maturation failure; duplex ultrasound; hemodynamics; LASSO regression; nomogram; prediction model

DOI：

10.7507/1002-0179.202606250

Video：

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Objective To develop and validate a nomogram based on Doppler ultrasound hemodynamics at 2 weeks post-surgery for predicting autogenous arteriovenous fistula (AVF) maturation failure. Methods Patients with end-stage renal disease who underwent first-time AVF surgery between March 2023 and September 2025 were selected. Patients were classified into the maturation group and maturation failure group according to AVF status at 6 weeks post-surgery. Predictive variables were screened using LASSO regression, and a nomogram was constructed via multivariable logistic regression. Model performance was evaluated using area under the curve (AUC), calibration curves, and decision curve analysis. Results A total of 260 patients were included. Among 260 patients, 94 (36.2%) experienced AVF maturation failure. Seven variables were selected by LASSO regression: female gender, diabetes, draining vein diameter, vascular access blood flow, pulsatility index, vein depth, and anastomotic stenosis. Multivariable logistic regression demonstrated that female gender, diabetes, smaller draining vein diameter, lower vascular access blood flow, and higher pulsatility index were independent predictors (P<0.05). The nomogram yielded an AUC of 0.924 [95%CI (0.893, 0.956)], with a bootstrap-corrected AUC of 0.912. The model showed good calibration (χ²=3.703, P=0.883) and clinical net benefit. Conclusion The established nomogram exhibits robust performance and can be integrated into the routine 2-week post-operative follow-up to facilitate early identification and individualized management of AVF maturation failure.

Citation： CAO Wen, HU Xiu, QING Wei, LIU Minglin, FENG Yu, ZHANG Li, XU Xiaoling, SONG Bin. Development and validation of a prediction model for maturation failure of autogenous arteriovenous fistula based on duplex ultrasound hemodynamic parameters at 2 weeks after surgery. West China Medical Journal, 2026, 41(7): 1077-1083. doi: 10.7507/1002-0179.202606250 Copy

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2.	Dember LM, Imrey PB, Beck GJ, et al. Objectives and design of the hemodialysis fistula maturation study[J]. Am J Kidney Dis, 2014, 63(1): 104-112.
3.	Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions[J]. Kidney Int, 2002, 62(4): 1109-1124.
4.	Ravani P, Palmer SC, Oliver MJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review[J]. J Am Soc Nephrol, 2013, 24(3): 465-473.
5.	Yap YS, Chi WC, Lin CH, et al. Association of early failure of arteriovenous fistula with mortality in hemodialysis patients[J]. Sci Rep, 2021, 11(1): 5699.
6.	Pisoni RL, Zepel L, Zhao J, et al. International comparisons of native arteriovenous fistula patency and time to becoming catheter-free: findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS)[J]. Am J Kidney Dis, 2021, 77(2): 245-254.
7.	王顏顏, 查筑紅, 王靜, 等. 貴州省 124 所醫療機構維持性血液透析相關感染現況調查[J]. 中國感染控制雜志, 2024, 23(1): 58-65.
8.	Yao X, Lei W, Shi N, et al. Impact of initial dialysis modality on the survival of patients with ESRD in eastern China: a propensity-matched study[J]. BMC Nephrol, 2020, 21(1): 310.
9.	胡春燕, 張海霞, 靳晶晶, 等. 不同類型長期血管通路對維持性血液透析患者預后影響的回顧性隊列研究[J]. 腎臟病與透析腎移植雜志, 2021, 30(6): 525-529.
10.	Meola M, Ibeas J, Lasalle G, et al. Basics for performing a high-quality color Doppler sonography of the vascular access[J].J Vasc Access, 2021, 22(Suppl 1): 18-31.
11.	Meng L, Guo W, Ho P. Risk score for the prediction of arteriovenous fistula maturation[J]. J Vasc Surg, 2025, 81(6): 1485-1494. e5.
12.	Zhao B, Wang H, Wang Y, et al. Nomogram-based prediction of the risk of AVF maturation: a retrospective study[J]. Front Med (Lausanne), 2024, 11: 1432437.
13.	Riley RD, Snell KI, Ensor J, et al. Minimum sample size for developing a multivariable prediction model: part II—binary and time-to-event outcomes[J]. Stat Med, 2019, 38(7): 1276-1296.
14.	Robbin ML, Greene T, Allon M, et al. Prediction of arteriovenous fistula clinical maturation from postoperative ultrasound measurements: findings from the Hemodialysis Fistula Maturation Study[J]. J Am Soc Nephrol, 2018, 29(11): 2735-2744.
15.	金其莊, 王玉柱, 葉朝陽, 等. 中國血液透析用血管通路專家共識(第 2 版)[J]. 中國血液凈化, 2019, 18(6): 365-381.
16.	Abreu R. New hemodynamic variables as predictors of arteriovenous fistula maturation[J]. Semin Dial, 2022, 35(4): 358-362.
17.	Tibshirani R. Regression shrinkage and selection via the lasso[J]. J R Stat Soc Series B Stat Methodol, 1996, 58(1): 267-288.
18.	Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors[J]. Stat Med, 1996, 15(4): 361-387.
19.	Robbin ML, Chamberlain NE, Lockhart ME, et al. Hemodialysis arteriovenous fistula maturity: US evaluation[J]. Radiology, 2002, 225(1): 59-64.
20.	Han M, Zhao Q, Zhao J, et al. Risk prediction models for autogenous arteriovenous fistula failure in maintenance hemodialysis patients: a systematic review and meta-analysis[J]. World J Surg, 2024, 48(10): 2526-2542.
21.	Giannikouris IE, Spiliopoulos S, Giannakopoulos T, et al. Evaluation of arteriovenous fistula maturation and early prediction of clinical eligibility, using ultrasound: the Fistula Maturation Evaluation (FAME) Study[J]. J Vasc Access, 2024, 26(3): 926-936.
22.	Polavarapu P, Patil SD, Patil S, et al. Role of Doppler ultrasound in the evaluation of arteriovenous fistula maturation and detection of complications in hemodialysis patients[J]. Cureus, 2025, 17(5): e84681.
23.	Pisoni RL, Zepel L, Fluck R, et al. International differences in the location and use of arteriovenous accesses created for hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)[J]. Am J Kidney Dis, 2018, 71(4): 469-478.
24.	曹雯, 宋斌, 廖祖春, 等. 德陽地區 1550 例維持性血液透析患者長期血管通路橫斷面調查分析[J]. 中國血液凈化, 2020, 19(2): 116-119.
25.	Allon M. Vascular access for hemodialysis patients: new data should guide decision making[J]. Clin J Am Soc Nephrol, 2019, 14(6): 954-961.
26.	Shahverdyan R. Radiocephalic and brachiocephalic fistulae//Principles of Dialysis Access[M]. Cham: Springer Nature Switzerland, 2024: 149-155.
27.	Hoffstaetter T, Silpe J, Delijani D, et al. Gender disparities in arteriovenous fistula maturation outcomes[J]. J Vasc Surg, 2022, 75(6): E299-E300.
28.	Akkaya ?, Arslan ü. Sex-specific impact of inflammation and nutritional indices on AVF blood flow and maturation: a retrospective analysis[J]. Diagnostics (Basel), 2025, 15(10): 1278.
29.	Satam K, Ohashi Y, Thaxton C, et al. Sex hormones impact early maturation and immune response in the arteriovenous fistula mouse model[J]. Am J Physiol Heart Circ Physiol, 2023, 325(1): H77-H88.
30.	White RE. Estrogen and vascular function[J]. Vascul Pharmacol, 2002, 38(2): 73-80.
31.	Matsubara Y, Kiwan G, Fereydooni A, et al. Distinct subsets of T cells and macrophages impact venous remodeling during arteriovenous fistula maturation[J]. JVS Vasc Sci, 2020, 1:207-218.
32.	Márquez EJ, Chung CH, Marches R, et al. Sexual-dimorphism in human immune system aging[J]. Nat Commun, 2020, 11(1): 751.
33.	Yang DR, Wang MY, Zhang CL, et al. Endothelial dysfunction in vascular complications of diabetes: a comprehensive review of mechanisms and implications[J]. Front Endocrinol (Lausanne), 2024, 15: 1359255.
34.	Liu S, Wang Y, He X, et al. Factors affecting suboptimal maturation of autogenous arteriovenous fistula in elderly patients with diabetes: a narrative review[J]. Heliyon, 2024, 10(15): e35766.
35.	Vazquez-Padron RI, Duque JC, Tabbara M, et al. Intimal hyperplasia and arteriovenous fistula failure: looking beyond size differences[J]. Kidney360, 2021, 2(8): 1360-1372.
36.	Ko SH, Bandyk DF, Hodgkiss-Harlow KD, et al. Estimation of brachial artery volume flow by duplex ultrasound imaging predicts dialysis access maturation[J]. J Vasc Surg, 2015, 61(6): 1521-1527.
37.	Inagaki K, Onogi C, Iimuro K, et al. Early postoperative resistance index can predict radiocephalic arteriovenous fistula failure[J]. J Vasc Access, 2025, 26(5): 1610-1618.
38.	He Y, Wei G, Greene T, et al. Hemodynamics are associated with subsequent lumen remodeling and clinical maturation of hemodialysis arteriovenous fistula[J]. Sci Rep, 2025, 15(1): 6131.

1. Lok CE, Huber TS, Lee T, et al. KDOQI clinical practice guideline for vascular access: 2019 update[J]. Am J Kidney Dis, 2020, 75(4)(Suppl 2): S1-S164.
2. Dember LM, Imrey PB, Beck GJ, et al. Objectives and design of the hemodialysis fistula maturation study[J]. Am J Kidney Dis, 2014, 63(1): 104-112.
3. Allon M, Robbin ML. Increasing arteriovenous fistulas in hemodialysis patients: problems and solutions[J]. Kidney Int, 2002, 62(4): 1109-1124.
4. Ravani P, Palmer SC, Oliver MJ, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review[J]. J Am Soc Nephrol, 2013, 24(3): 465-473.
5. Yap YS, Chi WC, Lin CH, et al. Association of early failure of arteriovenous fistula with mortality in hemodialysis patients[J]. Sci Rep, 2021, 11(1): 5699.
6. Pisoni RL, Zepel L, Zhao J, et al. International comparisons of native arteriovenous fistula patency and time to becoming catheter-free: findings from the Dialysis Outcomes and Practice Patterns Study (DOPPS)[J]. Am J Kidney Dis, 2021, 77(2): 245-254.
7. 王顏顏, 查筑紅, 王靜, 等. 貴州省 124 所醫療機構維持性血液透析相關感染現況調查[J]. 中國感染控制雜志, 2024, 23(1): 58-65.
8. Yao X, Lei W, Shi N, et al. Impact of initial dialysis modality on the survival of patients with ESRD in eastern China: a propensity-matched study[J]. BMC Nephrol, 2020, 21(1): 310.
9. 胡春燕, 張海霞, 靳晶晶, 等. 不同類型長期血管通路對維持性血液透析患者預后影響的回顧性隊列研究[J]. 腎臟病與透析腎移植雜志, 2021, 30(6): 525-529.
10. Meola M, Ibeas J, Lasalle G, et al. Basics for performing a high-quality color Doppler sonography of the vascular access[J].J Vasc Access, 2021, 22(Suppl 1): 18-31.
11. Meng L, Guo W, Ho P. Risk score for the prediction of arteriovenous fistula maturation[J]. J Vasc Surg, 2025, 81(6): 1485-1494. e5.
12. Zhao B, Wang H, Wang Y, et al. Nomogram-based prediction of the risk of AVF maturation: a retrospective study[J]. Front Med (Lausanne), 2024, 11: 1432437.
13. Riley RD, Snell KI, Ensor J, et al. Minimum sample size for developing a multivariable prediction model: part II—binary and time-to-event outcomes[J]. Stat Med, 2019, 38(7): 1276-1296.
14. Robbin ML, Greene T, Allon M, et al. Prediction of arteriovenous fistula clinical maturation from postoperative ultrasound measurements: findings from the Hemodialysis Fistula Maturation Study[J]. J Am Soc Nephrol, 2018, 29(11): 2735-2744.
15. 金其莊, 王玉柱, 葉朝陽, 等. 中國血液透析用血管通路專家共識(第 2 版)[J]. 中國血液凈化, 2019, 18(6): 365-381.
16. Abreu R. New hemodynamic variables as predictors of arteriovenous fistula maturation[J]. Semin Dial, 2022, 35(4): 358-362.
17. Tibshirani R. Regression shrinkage and selection via the lasso[J]. J R Stat Soc Series B Stat Methodol, 1996, 58(1): 267-288.
18. Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors[J]. Stat Med, 1996, 15(4): 361-387.
19. Robbin ML, Chamberlain NE, Lockhart ME, et al. Hemodialysis arteriovenous fistula maturity: US evaluation[J]. Radiology, 2002, 225(1): 59-64.
20. Han M, Zhao Q, Zhao J, et al. Risk prediction models for autogenous arteriovenous fistula failure in maintenance hemodialysis patients: a systematic review and meta-analysis[J]. World J Surg, 2024, 48(10): 2526-2542.
21. Giannikouris IE, Spiliopoulos S, Giannakopoulos T, et al. Evaluation of arteriovenous fistula maturation and early prediction of clinical eligibility, using ultrasound: the Fistula Maturation Evaluation (FAME) Study[J]. J Vasc Access, 2024, 26(3): 926-936.
22. Polavarapu P, Patil SD, Patil S, et al. Role of Doppler ultrasound in the evaluation of arteriovenous fistula maturation and detection of complications in hemodialysis patients[J]. Cureus, 2025, 17(5): e84681.
23. Pisoni RL, Zepel L, Fluck R, et al. International differences in the location and use of arteriovenous accesses created for hemodialysis: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)[J]. Am J Kidney Dis, 2018, 71(4): 469-478.
24. 曹雯, 宋斌, 廖祖春, 等. 德陽地區 1550 例維持性血液透析患者長期血管通路橫斷面調查分析[J]. 中國血液凈化, 2020, 19(2): 116-119.
25. Allon M. Vascular access for hemodialysis patients: new data should guide decision making[J]. Clin J Am Soc Nephrol, 2019, 14(6): 954-961.
26. Shahverdyan R. Radiocephalic and brachiocephalic fistulae//Principles of Dialysis Access[M]. Cham: Springer Nature Switzerland, 2024: 149-155.
27. Hoffstaetter T, Silpe J, Delijani D, et al. Gender disparities in arteriovenous fistula maturation outcomes[J]. J Vasc Surg, 2022, 75(6): E299-E300.
28. Akkaya ?, Arslan ü. Sex-specific impact of inflammation and nutritional indices on AVF blood flow and maturation: a retrospective analysis[J]. Diagnostics (Basel), 2025, 15(10): 1278.
29. Satam K, Ohashi Y, Thaxton C, et al. Sex hormones impact early maturation and immune response in the arteriovenous fistula mouse model[J]. Am J Physiol Heart Circ Physiol, 2023, 325(1): H77-H88.
30. White RE. Estrogen and vascular function[J]. Vascul Pharmacol, 2002, 38(2): 73-80.
31. Matsubara Y, Kiwan G, Fereydooni A, et al. Distinct subsets of T cells and macrophages impact venous remodeling during arteriovenous fistula maturation[J]. JVS Vasc Sci, 2020, 1:207-218.
32. Márquez EJ, Chung CH, Marches R, et al. Sexual-dimorphism in human immune system aging[J]. Nat Commun, 2020, 11(1): 751.
33. Yang DR, Wang MY, Zhang CL, et al. Endothelial dysfunction in vascular complications of diabetes: a comprehensive review of mechanisms and implications[J]. Front Endocrinol (Lausanne), 2024, 15: 1359255.
34. Liu S, Wang Y, He X, et al. Factors affecting suboptimal maturation of autogenous arteriovenous fistula in elderly patients with diabetes: a narrative review[J]. Heliyon, 2024, 10(15): e35766.
35. Vazquez-Padron RI, Duque JC, Tabbara M, et al. Intimal hyperplasia and arteriovenous fistula failure: looking beyond size differences[J]. Kidney360, 2021, 2(8): 1360-1372.
36. Ko SH, Bandyk DF, Hodgkiss-Harlow KD, et al. Estimation of brachial artery volume flow by duplex ultrasound imaging predicts dialysis access maturation[J]. J Vasc Surg, 2015, 61(6): 1521-1527.
37. Inagaki K, Onogi C, Iimuro K, et al. Early postoperative resistance index can predict radiocephalic arteriovenous fistula failure[J]. J Vasc Access, 2025, 26(5): 1610-1618.
38. He Y, Wei G, Greene T, et al. Hemodynamics are associated with subsequent lumen remodeling and clinical maturation of hemodialysis arteriovenous fistula[J]. Sci Rep, 2025, 15(1): 6131.

West China Medical Journal

Development and validation of a prediction model for maturation failure of autogenous arteriovenous fistula based on duplex ultrasound hemodynamic parameters at 2 weeks after surgery

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