https://doi.org/10.1177/1129729819830361
The Journal of Vascular Access
1–6
© The Author(s) 2019
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DOI: 10.1177/1129729819830361
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Introduction
A reliable and mature vascular access affects survival of a
hemodialysis patient and considered as lifeline for patients
on maintenance hemodialysis (MHD). Arteriovenous fis-
tula (AVF) is considered as gold standard access for
patients on MHD as AVFs are associated with lower mor-
tality and morbidity as compared to dialysis catheters.
1
With increasing prevalence of diabetes, and hyperten-
sion and subsequently end-stage renal disease (ESRD), it
is estimated that about 200,000 people enter into the pool
of ESRD population every year requiring renal replace-
ment therapy (RRT) in India.
2
Timely creation of vascular
access by only vascular surgeon is beyond the reach for
majority of ESRD patients. In India, AVF surgeries are
usually performed late as two-thirds of the patients see
nephrologists first time after they reach ESRD and dialysis
is initiated through temporary vascular access.
3
AVFs are
mainly made by urologists and vascular surgeons. Besides
old age and diabetes, lack of man power to create AVF
contributes to the non-availability of AVF for initiation of
dialysis.
Involvement of nephrologists in making AVF may help
in filling the gap between demand and supply of man power
Outcomes of radiocephalic fistula
created by nephrologists
Narayan Prasad
1
, Venkatesh Thammishetti
1
, DS Bhadauria
1
,
Anupama Kaul
1
, RK Sharma
1
, Aneesh Srivastava
2
and Amit Gupta
1
Abstract
Introduction: Arteriovenous fistula is considered as gold standard access for maintenance hemodialysis. Due to
increasing burden of end-stage renal disease requiring dialysis, it is important for nephrologists to complement creation
of arteriovenous fistula to meet the demand.
Methods: This retrospective study was designed to assess the outcomes of arteriovenous fistula made by nephrologists
at a tertiary care center from North India. The study included all radiocephalic arteriovenous fistula performed by
nephrologists between November 2015 and January 2017. All arteriovenous fistulas were performed in patients whose
duplex ultrasonography revealed both arterial and venous diameter of at least 2 mm. Data were collected with regard to
age, gender, dialysis status, basic diseases, co-morbidities, and mineral bone disease parameters. The predictors of the
primary and secondary patency rates were analyzed.
Results: Five hundred patients (age 39.3 ± 14.4 years; 82.4% males; 21.6% diabetics) were included. In total, 83 (16.6%)
patients had primary failure and 31 (7%) patients had secondary failure. Diabetes was associated with poor primary and
secondary patency rates. Mean survival among the patients without primary failure was 11 months. The primary patency
rates at 3, 6, 12, 18, and 21 months were 82%, 78%, 73%, 70%, and 70%, respectively.
Conclusion: To conclude, the outcomes of radiocephalic arteriovenous fistulas created by nephrologists are at par with
historic outcomes.
Keywords
Arteriovenous fistula, mineral bone disease, primary failure, secondary failure, stenosis, survival, thrombosis
Date received: 15 July 2018; accepted: 20 January 2019
1
Department of Nephrology, SGPGI, Lucknow, India
2
Department of Urology, SGPGI, Lucknow, India
Corresponding author:
Narayan Prasad, Department of Nephrology, SGPGI, Lucknow 226014,
Uttar Pradesh, India.
Email: narayan.nephro@gmail.com
830361JVA 0 0 10.1177/1129729819830361The Journal of Vascular AccessPrasad et al.
research-article 2019
Original research article