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Improving arteriovenous fistula rate: Effect on hemodialysis quality
Author(s) -
Karkar Ayman,
Chaballout Ahmed,
Ibrahim Maher Haj,
Abdelrahman Mohammed,
Al Shubaili Mona
Publication year - 2014
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12102
Subject(s) - medicine , hemodialysis , arteriovenous fistula , surgery , catheter , embolectomy , thrombosis , dialysis catheter , fistula , dialysis , end stage renal disease , vascular surgery , cardiac surgery , pulmonary embolism
Vascular access ( VA ) is the lifeline for patients with end‐stage renal disease on regular hemodialysis ( HD ). Tunneled catheters have been associated with increased risk of luminal thrombosis, infection, hospitalization, and high cost. Our aims were to follow the “ F istula F irst I nitiative,” avoid or reduce the rate of catheter insertion, improve the rate of arteriovenous fistula ( AVF ) use, and study the effect of increased AVF use on quality of dialysis and patient's outcome. A VA program has been established in collaboration with an enthusiastic and professional vascular surgery team to manage 358 patients who have been on regular HD treatment for a period ranging from 1 to 252 months. The mean ± standard deviation age of patients was 52 ± 15 years with 62% male patients. Over a period of 2 years, 408 procedures were performed. These include 293 AVFs and 56 arteriovenous grafts ( AVGs ). Other procedures include 39 permanent catheter insertions, 8 AVF aneurysmectomy, removal of 6 AVGs , embolectomy of 4 AVGs , excision of 1 AVG lymphocele, and ligation of 1 AVF . This program resulted in significant increase in AVF rate from 35% to 82%; reduction in catheter rate from 62% to 10.9%; infection rate down from 6.6% to 0.6%; VA clotting down from 5.1% to 1.0%; and increase in average blood flow rate from 214 ± 32 to 298 ± 37 mL/min (P < 0.01). These results have been associated with improved average single pool Kt/ V from 0.88 ± 0.19 to 1.28 ± 0.2 (P < 0.01); increased hemoglobin from 9.2 ± 1.2 to 10.9 ± 0.9 g/dL (P < 0.01); improved serum albumin from 3.2 ± 0.5 to 3.7 ± 0.4 g/dL (P < 0.05); reduction in administered erythropoietin dose by 19%; and significant drop in hospitalization rate from 6.1% to 3.8%. These results confirm the great benefits of AVF on quality of HD and patient outcome, and clearly affirm that AVF should always be considered first.