Outcomes of autogenous hemodialysis access at siriraj hospital

Background: The majority of hemodialysis cases in Thailand have used autogenous arteriovenous fistula (AVF), according to the recommendations in the 2006 KDOQI guideline. AVF maturation rate varies widely, from 25 to 80%. Many factors can affect the maturation rate. Objective: The intent of this study is to demonstrate the outcomes of autogenous hemodialysis access treatments performed at Siriraj Hospital, in the aspect of the rate of maturation and factors for maturation of AVF. Material and Method: All autogenous AVF created at Siriraj Hospital from July 2010 to February 2012 were included in this retrospective review. Patients with incomplete data and arteriovenous bridge grafts were excluded. The primary end point was the rate of fistula maturation and factors affecting maturation. Results: Of 147 access procedures, 104 fistulas exhibited 70% successful maturation. A maturation rate of 61%, or 57 radiocephalic fistulas created at the wrist was achieved. Four proximal radiocephalic fistulas were created with the rate of maturation of 75%. Forty-two brachio-cephalic fistulas were created with maturation rate achieved of 76%. Thirty-two brachio-antecubital fistulas were created which gave an 81% maturation rate. Twelve brachio-basilic fistulas were created and the maturation rate achieved was 67%. Wrist cephalic vein diameter of less than 2.5 mm gave an only 40% maturation rate. Vein diameter greater than 3.5 mm gave the best maturation of up to 100%. Also, the selection of small diameter elbow veins for fistula creation especially diameters of less than 2.5 mm resulted in poor maturation rate. Within this study the presence of diabetes mellitus and, or a hemodialysis catheter did not affect the rate of fistula maturation. Conclusion: Our experience showed an overall rate of fistula maturation at 70%. Brachio-basilic, brachio-antecubital, brachio-cephalic fistulas had the rate of maturation that of more than radiocephalic arteriovenous fistula, respectively. Vein diameter less than 2.5 mm should be avoided for fistula creation. Vein diameter more than 3.5 mm gave the best result for autogenous vascular access. Diabetes mellitus and, or the presence of a hemodialysis catheter were not factors affecting the AVF maturation.