Assessment of Factors Influencing Adequacy of Native Arteriovenous Fistula for Long Term Venous Access in Hemodialysis Patients.

Abstract

The prospectively designed study was conducted to determine adequacy of AVF in 130 patients over a period of two years. Adequacy of AVF was graded if the blood flow rate was higher or equal to 300 ml/ min on at least fifty percent of dialysis sessions in one month. AV-fistula adequacy was correlated with clinical and demographic factors like age, gender, diabetic status, smoking status, body mass index (BMI), serum calcium, serum phosphorus and Ca×P product, serum albumin and an evaluation for peripheral vascular disease (PVD). RESULTS: The study included 130 patients (68 males and 42 females). Early adequacy rate of 110 fistulas was 66% and 51% at end of 3 rd and 6 th months respectively. Diabetes was present in 41%, 32% were hypertensive and 27% of the patients were overweight (BMI ≥27 kg/m 2). The adequacy rate was lower in older (age ≥ 65) patients (34.0 vs. 57.6%, P = 0.028), in overweight (BMI ≥ 27 kg/m 2) patients (33.3 vs. 57.5%, P = 0.026). It was also marginally lower in diabetics versus nondiabetics (40.0 vs. 58%, P = 0.058) and the presence of peripheral vascular disease and increase calcium phosphorus product adversely affected AVF adequacy. The adequacy rate was not affected by patient smoking status and serum albumin. The adequacy rate was substantially lower for forearm versus upper arm fistulas (40.0 vs. 64%, P = 0.0131). The adequacy of forearm fistulas was particularly poor in women (13%), patients age 65 or older (12.5%), and diabetics (24%). In contrast, upper arm fistulas were adequate in