Creation and outcome of arteriovenous fistula for hemodialysis: experience in a tertiary care hospital in Saurashtra, Gujarat
Keywords:Arteriovenous fistula, Chronic kidney disease, Hemodialysis
Background: Patients with chronic kidney disease require arteriovenous fistulas for hemodialysis. The aim of our study was to share our experience of creating arteriovenous fistulas for hemodialysis and to analyze the factors affecting the outcome of arteriovenous fistulas.
Methods: This is a prospective study carried out in Guru Gobind Singh Government Hospital, Jamnagar from August 2013 to July 2015. All patients with chronic kidney disease in whom arteriovenous fistula was created surgically for hemodialysis were included in this study.
Results: Maximum patients (34%) were in the age group of 51-60 years. 76% of the patients were males and 24% were females. Co morbid conditions like diabetes mellitus, hypertension and ischemic heart disease were present in 20%, 26%, and 16% of patients respectively. Success rate of arteriovenous fistulas in patients with diabetes mellitus, hypertension and ischemic heart disease was 30%, 69.2% and 25% respectively. Success rate of arteriovenous fistulas in patients without diabetes mellitus, hypertension and ischemic heart disease was 92.5%, 83.8% and 90.5% respectively. Early failure was present in 20% of the patients. Most common cause of early failure was thrombosis, which occurred in 8% of total patients. Other causes of early failure were wound infection, stenosis and aneurysm, which occurred in 6%, 4% and 2% patients respectively.
Conclusions: Presence of diabetes mellitus and ischemic heart disease was associated with a higher risk of arteriovenous fistula failure. The success rate reported in our study was fairly acceptable.
Şahin M, Bıçakhan B, Akkoç İ. A Retrospective Evaluation of Outcomes of Arteriovenous Fistulas for Hemodialysis. Med Bull Haseki. 2018;56:28-31.
Salako AA, Badmus TA, Igbokwe MC, David RA, Laoye A, Akinbola IA, et al. Experience with arteriovenous fistula creation for maintenance hemodialysis in a tertiary Hospital in South-Western Nigeria. Saudi J Kidney Dis Transpl. 2018;29(4):924-9.
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney inter., Suppl. 2013;3:1-150.
National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis. 2006:48:S1-S322.
Sahasrabudhe P, Dighe T, Panse N, Patil S. Retrospective analysis of 271 arteriovenous fistulas as vascular access for hemodialysis. Indian J Nephrol. 2013;23:191-5.
Huijbregts HJT, Bots ML, Wittens CHA, Schrama YC, Moll FL, Blankestijn PJ. Hemodialysis Arteriovenous Fistula Patency Revisited: Results of a Prospective, Multicenter Initiative. Clin J Am Soc Nephrol. 2008;3:714-9.
Wang W, Murphy B, Yilmaz S, Tonelli M, Macrae J, Manns BJ. Comorbidities do not influence primary fistula success in incident hemodialysis patients: a prospective study. Clin J Am Soc Nephrol. 2008;3(1):78-84
Ravani P, Brunori G, Mandolfo S, Cancarini G, Imbasciati E, Marcelli D, et al. Cardiovascular comorbidity and late referral impact arteriovenous fistula survival: A prospective multicenter study. J Am Soc Nephrol. 2004;15:204-9.