EARLY VERSUS LATE ARTERIO-VENOUS FISTULAE: IMPACT ON FAILURE RATE
AbstractBackground: 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 vascularaccess. Arterio-venous (AV) fistula is the closest to be an ideal long-term haemodialysis vascularaccess. The creation of fistulas or grafts is recommended before starting haemodialysis, this study wasundertaken to determine the impact of timing of AV fistula creation on its failure rate. Methods: It is adescriptive study. All patients with chronic kidney disease (CKD) reporting to Armed Forces Instituteof Urology (AFIU) and Military Hospital (MH) Rawalpindi from January 2008 to October 2009 inwhom vascular access was created were included. The patients were followed prospectively and acomplete data about their haemodialysis and vascular access was maintained. Results: A total of 168permanent accesses were created in 112 patients in this study. The mean duration of follow-up was14.05±4.45 months. Early access creation group included 23 patients and late access creation groupincluded 89 patients. Out of 168 fistulas that were created, 54 fistulas failed with 45 (83.3%) of thesefrom patients of late access creation group. Age, gender and diabetes mellitus (DM) had no significantaffect on failure rate of fistulas. Conclusion: Timely referral to nephrologists and early creation ofpermanent vascular access by dedicated team work can improve the success rate of AV fistulae soenhancing quality of life of patients of end stage renal disease.Keywords: Nephrology consultation, Haemodialysis, Arterio-venous fistula
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