CLINICAL OUTCOMES AFTER ARTERIOVENOUS FISTULA CREATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Aim: Creation of an arteriovenous fistula (AVF) before initiation of haemodialysis (HD) is an important goal in chronic kidney disease (CKD) management. This study aims to determine outcomes and optimal timing for AVF creation in CKD patients. Methods: We reviewed records of all CKD patients who had a first AVF creation for future HD at Austin Health from 01/01/2007–31/12/2009 and obtained follow-up data until 31/12/2011. Survival analysis was performed for the primary outcome of time from AVF creation to first HD treatment. Results: In 100 patients who had a first AVF created, the mean age was 63.7 ± 13.7 years, 49 had diabetes and 39 were female. Mean time from AVF creation to first HD in 73 patients who commenced HD was 14.1 ± 12.7 (range: 0.2–47.7) months. Of these 73 patients, 21 (29%) required a radiological and/or surgical procedure before commencing HD and 26 (36%) required a procedure within 3 months of commencing HD. Despite AVF creation, 12 (16%) patients required a catheter to start HD and 2 (3%) required a catheter within 3 months of HD commencement. Median time to starting HD was 479 days. In patients with eGFR < 16 mL/min (the median) median time to starting dialysis was 321 days compared to 909 days for eGFR ≥ 16 ml/min (Log rank p = 0.018). At 3, 6 and 12 months respectively, 20%, 44% and 56% of patients with eGFR < 16 mL/min had commenced HD compared to 11%, 20% and 26% with eGFR ≥ 16 ml/min. Conclusion: While early AVF creation is an important goal, we demonstrate that optimal timing of AVF creation is challenging, with half of our patients not using the AVF for over a year, and many requiring subsequent AVF procedures before becoming established on HD.