The natural history of autologous fistulas as first-time dialysis access in the KDOQI era

Abstract

In patients receiving a first time permanent access, we found that the majority were AVF and they resulted in low primary patency rates at 1 year and long maturation times. KDOQI encourages AVF creation in order to increase AVF use for dialysis, but the strategy of simply increasing the number being created may not lead to the desired result and potentially lead to an increase in catheter dependence.

American Society of Nephrology Quiz and Questionnaire 2015: ESRD/RRT

“…Even if it could be created within 72 hours, it would still require approximately 4 weeks minimum to mature enough to support dialysis with the high blood flow rates prescribed in North America. However, average maturation times range from 4 to 9 months (30,31). In the interim, our patient would require a temporary CVC for dialysis.…”

Arteriovenous fistulas for hemodialysis in patients suffering from chronic renal failure: our experience as regards difficulties and complications

“…Primary patency at one year varies widely. [23][24][25][26][27] There were no major complications (Table 2) except in five cases in whom there was redness and cellulitis. For this, higher antibiotic cover was given and the cellulitis subdided.…”

Hemodialysis Principles and Controversies

“…However, a recent study of the practice patterns at dialysis facilities in DOPPS suggests that earlier cannulation of AVFs (even prior to 4 weeks) was not associated with increased risk of access failure (81). Other issues include a significant rate of primary failure of AVFs (82), vascular steal syndrome, inability to create AVFs because of lack of suitable vessels (82)(83)(84), and development of stenoses leading to AVF thrombosis and AVF failure (82)(83)(84). Given the significant time for their maturation, AVFs must be placed well before initiation of hemodialysis to avoid use of other accesses, such as tunneled catheters.…”

“…The advantage of an AVG is the high primary patency rate and minimal gap between creation and first use (84,86). Because of the presence of foreign material, there is increased risk of access infection, although less than that with tunneled catheters, and there is an increased rate of stenosis, thrombosis, and graft failure compared with AVFs.…”