A single centre experience of arteriovenous fistula creation for hemodialysis access in Dar es Salaam, Tanzania

Abstract

Chronic kidney disease (CKD) is increasingly diagnosed and thus more patients are in need of hemodialysis (HD) to sustain their life. The quality of vascular access for HD should be suitable for repeated puncture and allow a fast blood flow rate for high-efficiency dialysis with minimal complications. Our study aimed to document local experience and early outcomes after arteriovenous fistula (AVF) creation for hemodialysis access including complications related to AVF creation.This was a hospital based clinical audit in which case notes of patients who had undergone AVF creation between May, 2017 and March, 2018 at Muhimbili National Hospital (MNH) were reviewed using a structured data collection tool. Information regarding preoperative assessment for AVF creation, outcome of AVF, and age of the patients were collected. Descriptive statistics were prepared and summarized as tables. A total of 57 case notes of patients who underwent AVF creation for HD access with males contributing majority of patients (77.2%) were reviewed. The predominant age group was 41 to 60 years of age (56.2%) with mean age 47 years and age range of 18 -69 years. Three patients had procedure abandoned on the table due to sclerotic vein. The functional maturation rate was found to be 64.9% and post AVF complications in 15 patients (26.3%). Recorded post AVF creation complications were fistula stenosis/revision (27.8%), bleeding/haematoma (22.2%), limb oedema (22.2%), aneurysm (11.1%), surgical site infection [SSI] (11.1%) and thrombus formation (5.6%).AVF creation for HD access is common at MNH with a functional maturation rate of 64.9%, which is an acceptable rate. The preoperative vascular assessment in this survey was mainly found to be physical examination while preoperative vascular imaging was not commonly done to assess suitability of veins and arteries for AVF creation although post AVF complications are relatively few.

Factors Associated with Arteriovenous Fistula Maturation Failure among Patients Undergoing Hemodialysis in Hospitals Based in a Low and Middle-Income Country

“…(13) Despite of greater benefit of AVF, the procedure is not without adverse outcomes. Functional maturation failure was considered to be 35 per 100 patients who undergo AVF-creation at 8 weeks and resultant complications were aneurysm(11.1%), bleeding(22.2%), vascular thrombosis(5.6%) and stenosis(27.8%), surgical site infection(11.1%) and edema(22.2%) as described by Mtaturu et al 2020 (14). Also, Chan and others 2018 noted a maturation failure of 38 per 100patients at three months after AVF creation however, age, fistula location and vein size was independent factor for failure of maturation.…”