Outcomes of vascular access creation prior to dialysis: building the case for early referral.
A 2-year single institution experience of the successes and complications of arteriovenous fistula (AVF) creation before dialysis initiation is reported. Study cohort: all patients who underwent AVF creation before need for dialysis (AVF group, n = 125). "Control" group: all patients with a sustained glomerular filtration rate (GFR) <or=25 ml/min and eligible for AVF creation during the same time period, but did not have an access placed before dialysis (no AVF group, n = 198). Median nephrology contact time was >12 months in both groups and mean eGFR at creation (AVF group) was 12 ml/min. In the AVF group, 72% underwent a successful first AVF creation, 11% suffered AVF thrombosis, and 17% had a nonmaturing AVF before need for dialysis. Sixty-six percent (n = 23) of these latter patients underwent a second AVF creation and 48% were mature at dialysis initiation. During the study period, 70% (n = 88, AVF group) and 61% (n = 121, no AVF group) commenced dialysis. Impressively, 72% (n = 66) of the AVF group used a mature fistula as their first dialysis access. A snapshot of "access in use" at the 6-month mark of dialysis revealed the AVF group had a higher number of patients using an AVF (81% vs. 44%) and a lower number with catheters (19% vs. 56%, respectively, p = 0.001). In conclusion, the success rate of early AVF creation is reasonable and complications when identified can be remedied without the need for a catheter, thus ultimately maximizing the use of AVF in dialysis patients.
Weber
Catherine L
CL
Division of Nephrology, Department of Medicine, University British Columbia, Vancouver, British Columbia, Canada. cweber@providencehealth.bc.ca
Djurdjev
Ognjenka
O
Levin
Adeera
A
Kiaii
Mercedeh
M
D000368:Aged; D001164:Arteriovenous Fistula / Q000473:pathology*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D006435:Renal Dialysis / Q000379:methods*; D013927:Thrombosis; D016896:Treatment Outcome