title: An investigation into the practice of concurrent chronic ambulatory peritoneal dialysis catheter insertion and arteriovenous fistula formation in patients needing dialysis.
abstract: To review the practice of concurrent chronic ambulatory peritoneal dialysis catheter insertion and arteriovenous fistula formation in patients needing dialysis, we retrospectively assessed the results of arteriovenous fistula procedures, the risk factors for fistula failure, and the selection strategy used to choose which patients with end-stage renal disease would be given dialysis. We analysed the medical records of 136 patients who had first-time arteriovenous fistulae created between 1 July 1986 and 1 May 1994 at a public hospital in Sydney, Australia. As many as 36% of fistulae were never used (24.5% due to primary failure) and 30.1% of the fistulae used had to be abandoned for various reasons. In addition, 22.8% of patients experienced complications, the most common being thrombosis and stenosis. None of the factors associated with fistula formation were significant in terms of fistula patency rates, but smokers and female patients had inferior fistula patency rates. Whereas the overall results were satisfactory, the practice of concurrent chronic ambulatory peritoneal dialysis catheter insertion and arteriovenous fistula formation to give vascular access for dialysis is questionable.
authors.affiliation: Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
authors.forename: A K
authors.initials: AK
authors.lastname: Chui
authors.forename: E Y
authors.initials: EY
authors.lastname: Chiu
authors.forename: E A
authors.initials: EA
authors.lastname: White
authors.forename: T
authors.initials: T
authors.lastname: Yumiba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical; D002405:Catheterization, Central Venous; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome