Aim: To review the outcome of access created early in patients with Chronic Kidney Disease (CKD) stage 4 & 5.
Background
Timing of placement of access for dialysis in patients with CKD is uncertain, with most of the guidelines being opinion based.
Methods:
Data was collected from prevalent pre-dialysis patients, and followed up via CKD clinic. Monitoring included eGFR at the time of referral, access type, access complications/ interventions and eGFR at last visit. Access referral was based on consensus, when the eGFR was below 20 ml/min or dialysis initiation was anticipated within a year.
Results:
36 out of 196 patient population had an access created: 23 with Arterio-Venous Fistula (AVF) and 13 with a Tenckhoff catheter (TK). 3 patients had both created. The average eGFR prior to referral was 15.6 ml/min. The average follow up period for AVF and TK groups was 24.4 (7- 38) and 22 (5- 40) months respectively.
On follow up, 15 (65%) patients with AVF had complications (6 clotted, 7 stenosis, 2 required ligation of tributaries). Only 8 (34%) were working without complication at the last follow up. Similarly, 6 (46%) TK catheters were blocked and were removed following unsuccessful revisions.
Conclusion:
Early creation of access in CKD patients, though historically desirable, is associated with significant morbidity and futility. The results of this review influenced the access management of our CKD population, with both improved timing of surgical referrals and improved waiting times for access formation.