Systematic surveillance of arteriovenous fistula patency in renal failure patients – Our early experience

Abstract

Objective: Does systematic surveillance help improve arteriovenous fistula (AVF) patency and health economics in renal failure patients? Materials and Methods: As part of a quality initiative project, prospective data were maintained in the electronic medical records at the Sultan Qaboos University Hospital by our clinical nurse specialist, of AVFs created for patients requiring renal replacement therapy from December 2015. Beginning in January 2018, a surveillance program of patients undergoing intervention to improve patency of AVF was started. The records of these patients up to December 31, 2019, were accessed to see if the program helped improve patency, thereby reducing the number of emergency admissions and improving health economics. The minimum follow-up period was 8 weeks. Results: A total of 143 patients had AVFs created during the study period. Fifty-one patients required fistulogram with or without fistuloplasty. Thirty-six out of 51 (70%) fistulas remain patent, whereas 9 (18%) thrombosed and 6 (12%) were either lost to follow-up or deceased. The number presenting to the emergency department reduced by 50%. In addition, we observed a noticeable reduction in the number of emergency procedures required to sustain the fistula. Both duration of in-hospital stay and repetitive investigations were reduced. Conclusion: A surveillance program requires liaising with the patient, their relatives, local health center, regional dialysis unit, interventional radiology, nephrology, and vascular surgery team. We have seen a significant reduction in emergency interventions, increase in overall patency rate of AVFs, shorter in-patient hospital stays, and a decrease in number of laboratory investigations repeated.

Keywords

• arteriovenous fistula
• chronic kidney disease
• nurse specialist
• oman
• patency
• renal replacement therapy
• surveillance
• vascular