Abstract
Chronic Kidney Disease (CKD) affects 10-16% of the US population and its incidence is rising due to increasing prevalence of associated risk factors. Renal replacement therapy is required to treat late stage CKD and hemodialysis is the preferred modality for many patients. Vascular access is required for hemodialysis and arteriovenous fistulas (AVF) are currently the gold standard. This review intended to collate current knowledge on AVF outcomes regarding both the patient and fistula. Scopus and Medline were utilized to identify relevant literature. Inclusion and exclusion criteria were applied to narrow search results. Among CKD patients, 33.5-77.4% require a central venous catheter (CVC) before dialysis through a fistula. Many patients (33-51%) use a CVC regardless of AVF creation due to fistula immaturity or failure. There are large variations in AVF creation policies internationally; 16% of American hemodialysis patients use a fistula compared to 72% of German patients. Primary patency and primary AVFs' failure ranges from 60-70% and 20-26%, respectively. AVFs reduce morbidity and mortality in CKD. At present, too many patients are receiving hemodialysis through a CVC. Inadequate referral times for AVF creation can lead to fistula immaturity or failure in the intervention. Many countries are lagging behind recommended AVF creation rates published by the Kidney Disease Outcomes Quality Initiative. There is a paucity of literature concerning when a patient should be referred for AVF creation. It is paramount to have better predictive outcome measures and more clarity as to when patients will benefit from an AVF.
Highlights
Chronic Kidney Disease (CKD) is a pathologic condition resulting in a progressive decline of kidney function
All of the papers identified by the search methods were assessed for their quality and validity using the Evidence-based librarianship (EBL) critical appraisal tool.[27,28]
Of the patients who had an arteriovenous fistulas (AVF) created, 65% were able to cannulate it for HD, while 33% had to resort to a central venous catheter (CVC).[29]
Summary
Chronic Kidney Disease (CKD) is a pathologic condition resulting in a progressive decline of kidney function. It currently affects 7-12% of individuals globally, while its incidence is rapidly rising.[1,2,3,4] The disease involves structural pathology such as nephron loss and fibrosis, which result in decreased glomerular filtration.[5] These insults to the kidney contribute to systemic complications of CKD, including fluid and electrolyte abnormalities, anaemia, mineral-bone disorder, metabolic acidosis, hyperuricaemia, hypertension, dyslipidemia, cardiovascular disease and endocrine dysfunction.[5] Severity of the disease can be divided into five stages depending on estimated glomerular filtration rate (eGFR), with substantial loss of kidney function and end-stage renal disease (ESRD) comprising stages IV and V, respectively.[6,7,8] Renal replacement therapy is necessary once a patient has progressed to ESRD. Hemodialysis (HD) is often the modality of choice for patients in ESRD.[9]
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