Incidence and Risk factors for primary AV fistula failure

Abstract

Introduction: National Kidney foundation KDOQI Vascular access guidelines rank AVF as the best available access for hemodialysis. However a significant number of AVF (28 – 53%) fail to mature adequately to support dialysis therapy.This paper analyses the incidence and risk factors associated with primary fistula failure (PF). Material and Methods: From Jan 2000 to October 2007, patients who had an A V fistula for hemodialysis were included in the study. Baseline demographic data included age,gender,co morbidities, cause of renal failure and previous catheter use.Access characteristics recorded included access type,anatomic location,dates of creation and failure to mature.Univariate analysis was done to detect the risk factors associated with PF. Results: 116 AVF were created in 100 patients (M:F = 1.85:1; Mean age = 45.24 ± 20yrs).Co morbidities included Diabetes Mellitus (DM) in 72%, Hypertension in 84%, Coronary Artery Disease (CAD) in 27%, Cerebro Vascular Disease (CVD) in 03%, and Peripheral Vascular Disease (PVD) in 20%. Diabetic nephropathy was the most common cause of CRF(60%). Left side (84%) was most commonly used and Radiocephalic fistulae done in 55% patients.Primary fistula failure was seen in 44 (37%) patients.Risk factors included Distal Fistulae (81% vs 38%), Females (59% vs 19%) and DM (90% vs 61%), CAD (50% vs 13%) and PVD (36% vs 11%). Conclusions:Primary fistula failure was seen in 38% and Female sex, Radio cephalic fistulas and Diabetes mellitus,CAD and PVD are significant risk factors for PF.