Fistula First Initiative

Abstract

Background: Although AV fistula is considered as a gold standard for initiatinghemodialysis in patients with ESRD, the incidence is quite low in our population. Aim: Theaim of this study is to find out the incidence of permanent AV access i.e. AV fistula at the timeof first dialysis and causes leading to failure of this protocol. Study Design: Cross-sectionalstudy. Setting: Hemodialysis unit of Lahore General Hospital. Period: August-September,2017. Method: Patients undergoing hemodialysis in dialysis center of Lahore GeneralHospital. Results: Out of 82 patients recruited, only 4 patients were found to have their firsthemodialysis with AV fistula, remaining 78 patients had temporary double lumen catheter foremergency hemodialysis who were later on counselled to have AV fistula. Reasons include lackof counselling/awareness/education of disease in patients 71.79%, emergency HD in patientswith hypertensive emergencies 14.1%, and delay in maturation (7.6%) and failure (6.4%) ofAV fistula. Conclusion: To increase the incidence of fistula first initiative integration of differentprofessional teams are required as well as education and awareness should be instilled inpatients to help them in taking decisions.