Survival of arteriovenous fistula for dialysis at different centers in the North of England.
BACKGROUND
Renal failure patients rely on their vascular access for hemodialysis. Surgery for construction of arteriovenous fistulae is provided by a range of specialists. The aim of this review was to assess the survival of arteriovenous fistulae for hemodialysis patients in different centers of Northern England.


METHODS
Data was collected on 473 hemodialysis patients in the North of England. Risk factors for failure were determined for each patient (age, sex, diabetes), together with their current mode of dialysis and history of surgical access procedures. This was expressed against their duration of dialysis. The dialysis units were then compared for fistula survival using the Kaplan Meier method.


RESULTS
68.3% (323) patients were dialysed through via arteriovenous fistulae and 31.7% (150) via neck line. Overall fistula survival rates were 85.1% at 1 year, 82.5% at 2 years and 72.7% at 3 years. The best 1 year survival was 91.6% and worst 76.1%. These were 74.4% and 53.1% at 5 years and 74.4% and 29.5% at 10 years; these differences were highly statistically significant (p = 0.0033).


CONCLUSIONS
Though graft survival is affected by many things, surgical training in access surgery is not mandatory and a review of surgical practice is urgently needed.
Shrestha
P C
PC
Renal and Liver Transplant Unit, Freeman Hospital, Newcastle upon Tyne, UK. pukar@doctors.org.uk
Asher
J
J
Shrestha
S M
SM
Jenner
S
S
Wilson
C
C
Taylor
C
C
Rewcastle
T
T
Handerson
D
D
Wilson
M
M
Rix
D
D
Talbot
D
D
D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000193:education / Q000706:statistics & numerical data; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000193:education / Q000706:statistics & numerical data; D002983:Clinical Competence; D004739:England / Q000453:epidemiology; D005260:Female; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D006435:Renal Dialysis / Q000706:statistics & numerical data; D051437:Renal Insufficiency / Q000453:epidemiology / Q000628:therapy*; D013997:Time Factors; D017211:Treatment Failure