Introduction:
Arteriovenous fistula (AVF) is the preferred vascular access for maintenance hemodialysis due to its lower complication rates and superior long-term patency. However, despite recommendations for a 'fistula-first' approach, many patients in our setting initiate dialysis with tunneled or non-tunneled catheters. Delays in AVF creation are often due to late referral to nephrologists, patient comorbidities, or a lack of timely surgical evaluation. As a result, these patients experience multiple catheter placements and a high incidence of catheter-related bloodstream infections (CRBSIs).
Methods:
This study evaluates the clinical profiles, dialysis vintage, laboratory parameters, prior catheter use, and outcomes of AVF creation by nephrologists in these patients, aiming to improve vascular access strategies and patient outcomes.
Results:
This retrospective, single-center study analyzed data from 220 patients who underwent radiocephalic arteriovenous fistula (AVF) creation performed by nephrologists between January 2022 and December 2023. The cohort had a mean age of 38.2 years (range: 17-74 years), with 86.04% male patients. The primary diagnoses leading to end-stage renal disease included chronic glomerulonephritis (41.8%), diabetic kidney disease (18.6%), and chronic interstitial nephritis (20.9%). The average dialysis vintage was 70.5 days (range: 5-304 days). Patients had an average of 3.21 non-tunneled catheters (range: 1-14) and 0.28 tunneled catheters (range: 0-1). The average number of catheter-related bloodstream infection (CRBSI) events was 1.07 per patient (range: 0-4). Primary and secondary AVF failure rates at 6 months were 9.3% and 11.3%, respectively. Diabetes and female sex were associated with poorer outcomes for both primary and secondary AVF failure.
Conclusions:
Early referral and proactive management are crucial for optimizing arteriovenous fistula (AVF) outcomes. Despite delays and multiple catheter placements, the low failure rates at 6 months suggest that radiocephalic AVF is effective for dialysis access. However, diabetes and female sex are linked to higher failure rates, highlighting the need for targeted strategies to address these risk factors. Improving referral practices and preoperative assessments can further enhance AVF success and reduce complications like catheter-related bloodstream infections
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.