E CHUNG1, D KNAGGE1, L HEATH1, S CHEUNG1, H MCCOLL1, S MCGINN1, C FISHER1
1Royal North Shore Hospital, St Leonards, Australia
Aim: To review current practice and outcomes at a multi-centre renal unit with respect to decision making for haemodialysis access care.
Background: The gold standard of patients starting dialysis with a functional arteriovenous (AV) fistula is challenging, remaining static at around 40% in Australia.
Methods: A retrospective audit of AV access procedures on all patients requiring haemodialysis for more than 30 days at the Royal North Shore Dialysis Unit from 2010-2016 was performed combining Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Australian and New Zealand Society for Vascular Surgery audit, Access Coordinator Database and electronic medical records.
Results: 561 patients received haemodialysis for more than 30 days. Of these 198 were already on haemodialysis and 363 started haemodialysis. During the 7 years, 169 (30%) died, 97 received transplants (17%) and 22 transferred to other units. In keeping with ANZDATA, 60% patients started haemodialysis with a central venous catheter. Although 94 (34%) had an established AV fistula, only 82 were usable. For 87 patients, AV access was placed after haemodialysis commenced. Of the 271 patients new to renal replacement therapy, 180 (66%) had 193 AV accesses placed and 156 patients used their AV access. 66 patients underwent 189 revisions including new accesses. Functional AV fistulae had been placed a median (interquartile range) of 144 (70-388) days prior to dialysis. Of note, 53 patients had 57 AV fistulae without needing dialysis within the review period.
Conclusions: A relatively low proportion of patients commencing dialysis have a functioning AV fistula with a high number of revisions being required. A need for an algorithm for non-maturing AV fistulae to guide timely surgical intervention is identified.
Edmund Chung is currently a first year renal advanced trainee in the East Coast Network, NSW. He completed his undergraduate BMed MD at UNSW and postgraduate MMed (ClinEpi) at the University of Sydney. He has performed systematic reviews with the Cochrane Kidney and Transplant group and is passionate about better understanding how to limit the progression of chronic kidney disease.