Challenges and possibilities in Vascular Access Creation for Patients on Chronic Dialysis
Background and objectives: The population of patients on chronic hemodialysis (HD) is still growing. It is well known that the best vascular access for these patients is native arteriovenous fistula (AVF). Until now, there have been many discussions why some AVFs never become suitable for adequate HD. The aim of this study was to find the factors that could influence primary AVF dysfunction in patients on chronic hemodialysis.
Materials and Methods: Patients with chronic kidney disease stage V, older than 18 years and scheduled for the first AVF were invited to participate in the prospective observational study (n = 50). At the time of AVF creation, a surgeon obtained specimens of the vein, which were fixed in 10% formalin and processed for light microscopy. A pathologist examined the vein for intimal hyperplasia and vein medial fibrosis using Von Gieson staining. Ca, P and PTH were investigated in the patients’ blood. Before AVF formation, vascular mapping by ultrasound was performed. AVF suitability for dialysis within 3 months of AVF creation was determined clinically according to general recommendations
Results: Of 50 study patients, 38 AVFs successfully matured (76%), and in 12 cases (24%) early fistula dysfunction was diagnosed. According to the study data, early AVF dysfunction was not associated with arterial and vein diameters before fistula creation (P > 0.05) and vein intimal hyperplasia or media fibrosis (P > 0.05). The patients’ gender (P = 0.273), age (P = 0.228) and the main kidney disease (P = 0.321) were not statistically significant for early AVF dysfunction frequency.
Conclusions: 24% of the patients developed early AVF dysfunction. Neither arterial and vein diameters, nor vein intimal hyperplasia and media fibrosis were associated with early AVF dysfunction. Further investigations of the role of these factors in a large number of patients are necessary. Although this study did not demonstrate any benefit, preoperative vascular mapping is still recommended in order to prevent early AVF dysfunction for the patients with end-stage renal failure because we only used sufficient diameters vascular for creation arteriovenous fistulas.