Noh JW, Kim GH, Chun RW, Kim HF, Koo jR, Kim KH, Park KR,
Chae DW
Early use of arteriovenous fistula in hemodialysis patients
does not necessarily mean early failure of the fistula
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1415 1996
This study is about the length of time to wait before using an AVF for
chronic HD. The traditional rule has been to place an AVG if one needed
chronic access within a month and to place an AVF if dialysis wasn't
planned
for 2-3 months or longer, to give the AVF time to mature.
The authors analyzed their experience with 87 AVF and compared access
survival between a group in which AVF were used early (under 4 weeks) and
a group of patients in which AVF were used 4 weeks or more after
placement. They noted that AVF in the early use group remained open longer
than the more mature AVF group, except in diabetic patients. The authors
concluded that in urgent cases the AVFs could be used early and that the
predialytic state of the AVF may be more important than maturation time.
Comment: I was surprised by these findings. The authors can
demonstrate
significant differences at the 3-4 weeks threshold, that is traditionally
a fairly short maturing time. Nevertheless, it is encouraging to know that
some AVF can have an acceptable patency rate, if they look good at 4 weeks.
This experience from Korea, may not be applicable to the presumed older
USA patients with a 1/3 prevalence of diabetes mellitus.
(Jose Ganel, M.D., University of California Davis at Sacramento,
CA)
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Am Soc Nephrol
Basic hemodialysis :
Vascular Access: graft/fistula