CW NG1, G HARRIS1, C HOLMES1
1Bendigo Health, Bendigo, Australia
Aim: To study the prevalence and utility of backup arteriovenous fistula (AVF) in patients undergoing peritoneal dialysis (PD) at a rural centre in Victoria.
Background: There are ongoing debates on the need for creating backup AVF in PD patients. The practice varies across renal centres and nephrologists. Previous studies demonstrated low utility of backup fistula, suggesting that benefit of such practice is questionable.
Methods: This is a retrospective cohort study of adult PD patients managed at Bendigo Health from 1st January 2017 till 30th April 2018. Primary outcomes were the prevalence of backup AVF and its subsequent utility.
Results: Bendigo Health managed 43 PD patients between 1st January 2017 and 30th April 2018. 28 remained on PD at end of study period. 62.8% of patients were male (n=27) and 93% were Caucasian (n=40). Mean PD commencement age was 62 years (range 19-86 years). Mean therapy time was 900 days (range 7-3042 days). 27.9% (n=12) patients had backup AVF, 5 of which were constructed simultaneously with Tenckhoff catheter insertion. 5 backup fistulae were accessed, either following conversion to haemodialysis (n=4) or perioperatively during transplantation (n=1). 7 backup fistulae were never used, 4 of which were non-functional. 4 patients without backup fistula required percutaneous vascular catheter insertion while converting to haemodialysis, due to peritonitis warranting Tenckhoff catheter removal (n=2), inadequate dialysis (n=1), or abdominal surgery (n=1).
Conclusions: A quarter of PD patients at Bendigo Health had backup AVF created, but less than half of those fistulae were ever accessed, and one third were non-functional for haemodialysis access. Larger studies are required to identify subgroups of PD patients who are more likely to benefit from backup AVF formation.
Dr Chau Ng is the current Nephrology Advanced Trainee at Bendigo Health, Victoria.