Can the National Kidney Foundation Guidelines for First-Time Arteriovenous Fistula Creation Be Met in Underserved End-Stage Renal Disease Patients?

Abstract

The aims of this study were to determine whether National Kidney Foundation (NKF) guidelines for native arteriovenous fistula (AVF) creation (at least 50% of all new end-stage renal disease [ESRD] patients and 40% of prevalent hemodialysis patients) could be met in an underserved population who presented in late stages of ESRD. We also sought to determine 1-year AVF patency rates and factors associated with early thrombosis. One hundred seventy-six patients underwent hemodialysis access surgery during the period 2003-2005 with a mean age of 51 years. Sixty-two percent were male, and 48% had diabetes mellitus. Ultrasound vein mapping was performed in only 37%. Temporary central venous access was necessary in 109 patients (62%) due to late presentation. Of the 160 patients who were first-time access, 137 (86%) received a native AVF and 23 (14%) had an arteriovenous graft. There was a higher rate of AVF creation in males (91% vs. 75% for females, p = 0.005). The 1-year primary patency was 90%. There were no differences in early thrombosis or 1-year patency rates with respect to gender, age, ethnicity, insurance status, presence of temporary access, or use of preoperative vein mapping. In an underserved population, NKF guidelines for native AVF for first-time access can be superseded with an excellent 1-year patency, despite late presentation.