ASSESSMENT OF FACTORS INFLUENCING ADEQUACY OF NATIVE ARTERIOVENOUS FISTULA FOR LONG TERM VENOUS ACCESS IN HEMODIALYSIS PATIENTS.
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2013, Vol 2, Issue 13
Abstract
[b]OBJECTIVE[/b]:-The aim of our study was to assess the factors affecting adequacy of arteriovenous fistula (AVF) and to correlate it with clinical and demographic factors. [b]MATERIAL AND METHODS[/b]: 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 3rd and 6th months respectively. Diabetes was present in 41%, 32% were hypertensive and 27% of the patients were overweight (BMI ≥27 kg/m2). The adequacy rate was lower in older (age ≥ 65) patients (34.0 vs. 57.6%, P = 0.028), in overweight (BMI ≥ 27 kg/m2) 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 in59.2% of women, 56.3% of older patients, 54% of diabetics, and 30% of those having moderate to severe PVD.[b] CONCLUSIONS[/b]: Fistula adequacy and survival appear to be dependent on individual comorbid conditions and the integrity of the vasculature. Discriminant AVF site selection and adequate preoperative assessment of the vasculature remain crucial to AVF survival.
Authors and Affiliations
Shahid Abbas, Sharad Khandelwal, Riaz Hussain, Zubin Gandhi, Himanshu Dagor, Pranay Bajpai, Gunjan Shrivatava, Jha R. K
Keywords
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- EP ID EP117332
- DOI 10.14260/jemds/497
- Views 105
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