• Zahid Farooq
  • Arshad Mehmood
  • Shahzad Saeed
  • Khalid Mehmood Raja
  • Malik Nadeem Azam Khan
  • Badar Murtaza


Background: 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


Kinchen KS, Sadler J, Fink N, Brookmeyer R, Klag MJ, Levey

AS, et al. The timing of specialist evaluation in chronic kidney

disease and mortality. Ann Intern Med 2002;137:479–86.

Arora P, Obrador GT, Ruthazer R, Kausz AT, Meyer KB,

Jenuleson CS, et al. Prevalence, predictors and consequences of

late nephrology referral at a tertiary care center. J Am Soc

Nephrol 1999;10:1281–6.

Schmidt RJ, Domico JR, Sorkin MI, Hobbs G. Early referral and

its impact on emergent first dialyses, health care costs, and

outcome. Am J Kidney Dis 1998;32:278–83.

Ifudu O, Dawood M, Iofel Y, Valcourt JS, Friedman EA.

Delayed referral of black, Hispanic, and older patients with

chronic renal failure. Am J Kidney Dis 1999;33:728–33.

Jungers P, Massy ZA, Khoa NT, Choukroun G, Robino C,

Fakhouri F, et al. Longer duration of predialysis nephrological

care is associated with improved long-term survival of dialysis

patients. Nephrol Dial Transplant 2001;16:2357–64.

Stack AG. Impact of timing of nephrology referral and preESRD care on mortality risk among new ESRD patients in the

United States. Am J Kidney Dis 2003;41:505–7.

NKF-K/DOQI Clinical Practice Guidelines for Vascular Access:

Update 2000. Am J Kidney Dis 2001;37:S137–81.

Reddan D, Klassen P, Frankenfield DL, Szczech L, Schwab S,

Coladonato J, et al. National profile of practice patterns for

hemodialysis vascular access in the United States. J Am Soc

Nephrol 2002;13;2117–24.

Pisoni RL, Young EW, Dykstra DM, Greenwood RN, Hecking

E, Gillespie B, et al. Vascular access use in Europe and the

United States: Results from the DOPPS. Kidney Int


Hoen B, Dauphin PA, Hestin D, Kessler M. EPIBACDIAL: a

multicenter prospective study of risk factors for bacteremia in

chronic hemodialysis patients. J Am Soc Nephrol 1998;9:869–76.

Powe NR, Jaar B, Furth SL, Hermann J, Briggs W. Septicemia in

dialysis patients: incidence, risk factors, and prognosis. Kidney

Int 1999;55:1081–90.

Anees M, Mumtaz A, Nazir M, Ibrahim M, Rizwan SM, Kausar

T. Referral pattern of hemodialysis patients to nephrologists. J

Coll Phys Surg Pak 2007;17:671–4.

Ethier J, Mendelssohn DC, Elder SJ, Hasegawa T, Akizawa T,

Akiba T, et al. Vascular access use and outcomes: an

international perspective from the dialysis outcomes and practice

patterns study. Nephrol Dial Transplant 2008;23:3219–26.



Most read articles by the same author(s)