Standardized Duplex Doppler Imaging for Predicting Arteriovenous Fistula Maturation: A Prospective Ultrasound Study

Abstract Background: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, yet high early failure rates remain a clinical challenge. The utility of preoperative Duplex Doppler ultrasound parameters in predicting successful AVF maturation remains debated, especially in Indian populations where prospective data are limited. To assess whether preoperative Duplex Doppler ultrasound parameters can predict AVF maturation and to evaluate the role of postoperative flow rate in determining successful outcomes. Methods: This prospective study included 53 chronic kidney disease (CKD) patients undergoing AVF creation. Preoperative Duplex Doppler ultrasound evaluated cephalic and basilic vein diameters, radial artery diameter, peak systolic velocity (PSV), intima–media thickness, and vein depth. AVF maturation was assessed clinically and sonographically at 6 weeks. Logistic regression and receiver operating characteristic (ROC) analysis were used to examine associations. Results: No significant association was found between preoperative vessel parameters and AVF maturation ( P > 0.05). The overall maturation rate was 86.8%. Postoperative flow rate was significantly higher in matured AVFs (942.6 ± 322.1 mL/min) than in nonmatured AVFs (436.2 ± 101.4 mL/min; P < 0.001). A cutoff of 542 mL/min predicted maturation with 100% sensitivity and 85.7% specificity (area under the ROC curve = 0.913). Conclusion: Preoperative Doppler parameters may not independently predict AVF maturation. Postoperative flow rate is a strong predictor, and the conventional 600 mL/min threshold may not be universally applicable. Further multicentric prospective studies are required to validate region-specific thresholds.