PARAMETERS TO PREDICT FUNCTIONAL MATURATION AND OUTCOMES OF ARTERIOVENOUS FISTULA IN END STAGE RENAL DISEASE PATIENTS: A SINGLE CENTRE STUDY

Abstract

Background: The 'gold standard' vascular access for haemodialysis is an endogenously created arteriovenous stula (AVF). AVF is the most preferred mode of vascular access because this mode is mostly devoid of infection, gives a high blood ow rate, and has least chances of clot formation. The main purpose of this study is to predict the factors affecting AVF maturation and outcomes in patients with end stage renal disease. Methods: This is a prospective observational study conducted from July 1, 2017 to December 31, 2018. Out of 150 patients consented for surgery, 5 patients died during the follow up period and 2 patients were lost to follow up. Patients were divided into AVF functional group that included 81.8% (n=117) patients and AVF failure group (18.2%, n=26). All patients were followed at 2 weeks, 4 weeks, 6 weeks and at 12 months. Results: Male sex had more AVF failure rate than female sex. Patients having associated comorbidities had comparable risk of non-maturation of AVF (18.0%, p= 0.87). Diabetic nephropathy (50.3%) followed by hypertensive nephrosclerosis (37.8%) were most common causes of ESRD. RCF had the best patency rate as compared to BCF and BBF (p= 0.28). Vein as well as artery diameter was not found to be a signicant factor for AVF maturation (p value > 0.05). Most common cause of AVF failure was found to be thrombosis (11.9%) followed by stenosis (3.5%), infection (2.1%), pseudoaneurysm (0.7%). Conclusion: Neither gender nor vessel, vein as well as artery, diameters affected patency rates of AVF. Smoking had a predictive relationship with non-maturation of AVF. RCF had the best patency rate as compared to BCF and BBF. There was no signicant statistical relationship between types of AVF, surgeons experience, site, associated comorbidity and AVF patency rate. Duplex vein mapping should be done for all the cases of AVF surgery to obtain better patency rates.