title: Patients characteristics and outcome of 518 arteriovenous fistulas for hemodialysis in a sub-Saharan African setting.
abstract: BACKGROUND
  To present the particular aspects of arteriovenous fistula (AVF) for hemodialysis in sub-Saharan Africa in terms of patients' characteristics, patency and complication rates, as well as factors influencing them.
  
  
  METHODS
  From November 2002 to November 2009, 518 fistulas were constructed on adults. Demographic data, patency, and complications were analyzed. The association between age, sex, and comorbidities (HIV, hypertension, diabetes) on one hand and complications as well as AVF patency on the other was sought.
  
  
  RESULTS
  Males represented 73.7% of the patient population, and the mean age of the population was 45.3 years. As far as etiologies of end-stage renal disease (ESRD) and comorbidities are concerned, chronic glomerulonephritis was the leading cause of ESRD (134; 25.9%), followed by hypertension (22.3%), although prevalent in 83.2% of patients, and diabetes (20.1%), although prevalent in 22.2%. No cause for the ESRD could be identified in 89 patients (17.2%). Only 20.64% had AVF as the initial vascular access. The main types of AVF constructed were radiocephalic (68%) and brachiocephalic (24.9%). The median follow-up period was 275 days. The cumulative patency rate at 1 year and 2 years was 76% and 51%, respectively. Altogether, 188 complications occurred in 16% of the AVFs. Aneurysms, failure to mature, and thrombosis were the most frequent complications occurring in 27.65%, 14.89%, and 10.63% of cases, respectively. The management options for the complications included the creation of a new access for 63 complications (33.51%) and nonoperative management in 44.14% of the cases. We found no adverse effect of comorbid factors like diabetes mellitus (χ(2) = 3.58, P > 0.05) and HIV-positive status (χ(2) = 0.64, P > 0.05) on the complications rate.
  
  
  CONCLUSIONS
  According to our patients' characteristics, there is a possibility of constructing AVF on nearly every hemodialysis patient with a good outcome.
authors.affiliation: Department of Surgery, Yaoundé General Hospital, Yaounde, Cameroon. mfokou@yahoo.com
authors.forename: Marcus
authors.initials: M
authors.lastname: Fokou
authors.forename: Gloria
authors.initials: G
authors.lastname: Ashuntantang
authors.forename: Abel
authors.initials: A
authors.lastname: Teyang
authors.forename: Francois
authors.initials: F
authors.lastname: Kaze
authors.forename: Alain
authors.initials: A
authors.lastname: Chichom Mefire
authors.forename: Marie Patrice
authors.initials: MP
authors.lastname: Halle
authors.forename: Fru
authors.initials: F
authors.lastname: Angwafo
authors.forename: Samuel
authors.initials: S
authors.lastname: Takongmo
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Sandmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000783:Aneurysm / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects; D002163:Cameroon / Q000453:epidemiology; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult