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20 Early Arteriovenous Fistula Construction–Late Beginning of Hemodialysis Treatment?
Author(s) -
Malovrh M
Publication year - 2005
Publication title -
therapeutic apheresis and dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.415
H-Index - 53
eISSN - 1744-9987
pISSN - 1744-9979
DOI - 10.1111/j.1526-0968.2005.222_20_20.x
Subject(s) - medicine , creatinine , hemodialysis , arteriovenous fistula , renal function , uremia , surgery , urology , gastroenterology
It was noticed that the decline of renal function was slower in patients (pts) with end stage renal disease (ESRD) after early arteriovenous fistula (AVF) construction. The aim of this prospective study was to find out the influence of AVF on the progression of renal failure. Patients and methods Sixty ESRD pts with serum creatinine level (SCL) between 400 and 500 µmol/L were included and randomized in two groups. One group of pts received AVF and the other did not. Serum creatinine level, creatinine clearance (CC), and mean arterial pressure (MAP) were followed every two months for one year. All pts were clinically evaluated for signs of cardiac insufficiency. Hemodialysis (HD) was started when SCL was 850 µmol/L or CC 10 mL/min or when signs of uremia were presented. Results In Group A, 30 ESRD pts, 17 males and 13 females, age 61 ± 7.3 years, mean SCL 446.4 ± 30.5 µmol/L, mean CC 29.3 ± 4.1 mL/min, native forearm AVFs were constructed. No AVFs were constructed in Group B, 30 pts, 12 males and 18 females, mean age 62.8 ± 8.2 years, mean SCL 447.6 ± 37.6 µmol/L, mean CC 29.1 ± 4.7 mL/min. Mean SCL during a 12 month period in both groups is shown in Table A20. A20 Serum creatinine in a 12 month period (µmol/L)Group A Group BStart 446.4 ± 30 447.6 ± 37 2 months 451.9 ± 39 472.8 ± 39 * 4 months 466.4 ± 43 508.0 ± 60 * 6 months 482.8 ± 77 579.6 ± 123 ** 8 months 493.1 ± 73 612.7 ± 127 ** 10 months 494.3 ± 74 653.0 ± 141 ** 12 months 509.2 ± 50 660.3 ± 123 ***P < 0.05,**P < 0.01.After 12 months in Group A, 4/30 pts (13%) (1 after 6 months, 2 after 8 months, 1 after 10 months) started hemodialysis (HD), 26 pts had mean CC 23.1 ± 4.5 mL/min, MAP was 118 mmHg, no sign of cardiac insufficiency was found. In Group B, 11/30 (37%)( P < 0.01) (1 after 4 months, 5 after 6 months, 4 after 8 months, 1 after 10 months) started HD, central vein catheter was used as a vascular access. In the remaining 19 pts mean CC 15.6 ± 4.5 mL/min ( P < 0.01), MAP was 123 mmHg (NS). Conclusions This prospective study confirmed our previous observations of renal function after AVF construction. Besides matured AVF, the before‐HD benefit of early AVF on progression of renal insufficiency can be important. The reasons for this are not well known. There are two possibilities: increased cardiac output and decreased resistance of intrarenal vessels. Measurement of renal perfusion and calculation of resistance index by duplex sonography is planned.