Profile of Arteriovenous Fistula Surgery in Patients with Chronic Kidney Disease at a Tertiary Care Urology Hospital Karnataka, India: A Prospective Interventional Study

Introduction: Haemodialysis (HD) is the most important treatment approach in patients with Chronic Kidney Disease (CKD), awaiting kidney transplantation, demanding the long-term need for dialysis access.

Aim: To study the profile of Arteriovenous Fistula (AVF) surgery in patients undergoing haemodialysis in the Karnataka region, India.

Materials and Methods: This prospective, interventional single-centre study was conducted at the Institute of Nephrology and Urology, KR Hospital Campus, Mysuru, India, from April 2018 to April 2021. All the patients undergoing haemodialysis with AVF aged between 11-90 years were included. Demographic details (age, sex, co-morbidities) and fistula-related complications associated with surgery were examined in the immediate, late, and delayed postoperative period. Categorical variables were presented as numbers and percentages whereas, continuous variables were expressed as mean {Standard Deviation (SD)}. The data was collected in excel sheet and the statistical analysis was performed using Statistical Package for Social Sciences (SPSS), version 20.0.

Results: In total, 200 patients with a mean (SD) age of 48.8 (13.0) years underwent AVF formation and the majority were below <60 years of age (n=154, 77.0%). The incidence of fistula surgery and patency rates was higher in men (n=140, 70.0%). Most patients had left non dominant arm (n=187, 93.5%) and remaining right non dominant arm (n=13, 6.5%). The most common site of AVF was left brachial cephalic (n=135, 67.5%). The most common cause of CKD was diabetes mellitus (n=90, 45.0%). The most common immediately observed complications were bleeding (n=13, 6.5%), pain (n=12, 6.0%) and oedematous limb (n=5, 5.0%). Stitch abscess was the most common late complication observed in 14 patients (7%). Rupture of the aneurysm and AVF failure were delayed complications observed in eight (1.5%) and 17 (8.5%) patients, respectively.

Conclusion: In this study, bleeding, stitch abscess and AVF failure were found to be the most common immediate, late, and delayed postoperative complications, respectively. However, more studies are required to understand the outcome of AVF in Chronic Renal Failure (CRF) patients from India.