EARLY VERSUS LATE ARTERIO-VENOUS FISTULAE: IMPACT ON FAILURE RATE
Abstract
Background: Haemodialysis is the primary mode of renal replacement therapy for patients of endstage renal disease. The most important determinant for effective haemodialysis is a reliable vascular
access. Arterio-venous (AV) fistula is the closest to be an ideal long-term haemodialysis vascular
access. The creation of fistulas or grafts is recommended before starting haemodialysis, this study was
undertaken to determine the impact of timing of AV fistula creation on its failure rate. Methods: It is a
descriptive study. All patients with chronic kidney disease (CKD) reporting to Armed Forces Institute
of Urology (AFIU) and Military Hospital (MH) Rawalpindi from January 2008 to October 2009 in
whom vascular access was created were included. The patients were followed prospectively and a
complete data about their haemodialysis and vascular access was maintained. Results: A total of 168
permanent accesses were created in 112 patients in this study. The mean duration of follow-up was
14.05±4.45 months. Early access creation group included 23 patients and late access creation group
included 89 patients. Out of 168 fistulas that were created, 54 fistulas failed with 45 (83.3%) of these
from patients of late access creation group. Age, gender and diabetes mellitus (DM) had no significant
affect on failure rate of fistulas. Conclusion: Timely referral to nephrologists and early creation of
permanent vascular access by dedicated team work can improve the success rate of AV fistulae so
enhancing quality of life of patients of end stage renal disease.
Keywords: Nephrology consultation, Haemodialysis, Arterio-venous fistula
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