Abstract
The pathogenesis of arteriovenous fistula (AVF) maturation failure is unclear. We evaluated the associations of wall shear stress (WSS) with subsequent AVF remodeling and clinical maturation using regression models in this prospective cohort study. Participants underwent duplex ultrasound at postoperative Day 1, Week 2, and Week 6 to measure AVF blood flow rate and diameter of the draining vein and proximal artery. The median vein WSS of 602 participants decreased from Day 1 to Week 6 (from 33.4 to 21.6 dyne/cm(2)) but did not change noticeably for the artery (from 58.4 to 55.1 dyne/cm(2)). WSS was positively associated with subsequent lumen expansion, with doubling of Day-1 WSS presaging a 9% (95% confidence interval (CI) 5%-14%; P < 0.001) greater Day 1-to-Week 6 increase in vein lumen cross-sectional area and a 5% (95% CI: 1%-10%; P = 0.020) greater increase in artery lumen area. The odds of unassisted clinical maturation increased by 45% (95% CI: 11%-89%; P = 0.006) with each doubling of Day-1 vein WSS, and by 82% (95% CI: 39%-250%; P < 0.001) with each doubling of Day-1 artery WSS. These findings show that WSS was positively associated with subsequent lumen expansion and AVF unassisted clinical maturation.