#5446 A COHORT OF DIALYSIS PATIENTS WITH LOW PREVALENCE OF UPPER ARM FISTULAS

Abstract

Abstract Background and Aims International guidelines encourage the use of distal native fistula (AVF) which is the best first-line vascular access (VA). But, despite these indications, all over the world, except for Japan, the prevalence of upper arm fistula (UAF) is dramatically increasing. Previous surveys in our department included about 50% of Haemodialysis patients (HP) and showed prevalence of UAFs less then 5%–very low, if compared with those of our country, reported by DOPPS 5 study. We decided to analyse 100% of HP in our department, in order to confirm or exclude the low prevalence of UAF. Method Puglia, southern east of Italy, has 1.4 millions inhabitants, of which 1365 need dialysis; 1295 on haemodialysis in 17 different centers and 70 on peritoneal dialysis. The department is organized on a Hub and Spoke model for VA management (Fig. 1). Hub performs simple and complex AVFs, Graft, PTA of non matured or stenotic fistulas, PTA of central stenosis, and surgical rescue of thrombosed or stenotic fistulas. Our four spokes perform mainly simple distal forearm fistula (DFF). In December 2021 we collected datas of VA prevalence of all 1295 HP. The AVFs were classified, according to their anatomical site, in DFF, mean-proximal forearm fistula (MPFF) and UAF. Results The average age of 1295 HP was 69 ± 14,65% yo (65% males and 21% diabetics) and 458 of them (35%) where more than 75 yo. The prevalence of DFF, MPFF, UAF, GRAFT and CVC was 63.5%, 10.1%, 3%, 0.7%, 22.5% respectively (fig. 2). Patients aged ≥75 years, women and diabetics showed a higher prevalence of CVC and a lower prevalence of DFF. Conclusion Data collected on all patients confirm the low prevalence of UAF detected in the previous surveys -which involved only a part of haemodialysis patients. Zero upper arm fistulas is an utopian goal, but it seems possible to reduce the prevalence of proximal fistulas to 5% or less as the Japanese experience has showed.