Distribution and complications of native arteriovenous fistulas in maintenance hemodialysis patients: a single-center study.

BACKGROUND

The aim of this study was to investigate the use of vascular access in maintenance hemodialysis (MHD) patients and the complications of native arteriovenous fistulas (NAVFs) in a Chinese single center.

METHODS

Patients (n=376) were recruited in our descriptive cross-sectional study, 350 of them had wrist NAVFs (wrist group),and 18 of them had elbow NAVFs (elbow group). We evaluated the complications associated with NAVFs and the prevalence of high-output cardiac failure between these 2 groups. All statistical analyses were performed with the use of the SPSS software package, version 17.0. Data were expressed as means ± SD; a p value <0.05 was assumed to be statistically significant.

RESULTS

We found 97.87% of patients had NAVFs, among them 93.09% (350/376) of patients had wrist NAVFs, followed by elbow NAVFs 4.79% (18/376), while 1.33% (5/376) had graft AVFs and only 0.80% (3/376) of patients depended on a cuff catheter. The most frequent complications seen in our patients were thrombosis (13.86%), followed by aneurysm (12.23%), anastomotic stenosis (2.17%); arterial steal syndrome (1.63%); infection (0.54%); and venous hypertension (0.27%). Aneurysm was more common in the elbow group (66.67%) than in the wrist group (9.43%) (p<0.01). There were no differences in other complications, patency rate during 1-3 years or Kt/V between the 2 groups. We did not find high-output cardiac failure related to NAVFs in our patients.

CONCLUSION

The prevalence of complications of NAVFs is high, and greater attention should be paid to the prevention of these complications. Early diagnosis and management of complications related to AVFs is essential to prevent loss of the vascular access. We think the wrist radiocephalic NAVF is the first choice for MHD patients; an elbow NAVF is a reasonable alternative for MHD access when a radiocephalic NAVF is not possible.