Authors (including presenting author) :
Shum TS (1), Poon KY (1), Cheuk A (1)
Affiliation :
Department of Medicine & Geriatrics, Princess Margaret Hospital
Keyword 1: :
Arteriovenous Fistula
Keyword 2: :
Surveillance
Keyword 3: :
Hemodialysis
Introduction :
Vascular access is essential for hemodialysis. Preventing complications is crucial to reduce access abandonment, hospitalization, and emergency interventions. While clinical evidence suggests arteriovenous fistula (AVF) surveillance may be beneficial, high-quality evidence is lacking.
Objectives :
To compare outcomes between hemodialysis patients receiving AVF surveillance versus those without, specifically in rates of fistula thrombosis, access loss, fistula-related emergency hospital admissions, and angioplasty.
Methodology :
A retrospective cohort study included patients with newly created Radio-cephalic, Brachio-cephalic, or Brachio-basilic AVFs from June 2021 to November 2023. Of 63 cases, 17 were excluded (AV grafts, primary failure, or not tolerant to hemodialysis). The remaining 46 patients were categorized based on surveillance status: 33 patients underwent surveillance, while 13 did not. Outcomes were analyzed and compared between groups.
Result & Outcome :
The two groups were comparable in age, sex, cardiovascular disease, fistula type, and follow-up period (mean 2.75 years). Diabetes mellitus was more prevalent in the surveillance group (57.6% vs 15.4%, p=0.019). The surveillance group demonstrated lower rates of both thrombosis (0.065 vs 0.088 per patient-year; rate ratio 0.684, p=0.566) and access loss (0.011 vs 0.029 per patient-year; rate ratio 0.368, p=0.387), although these differences did not reach statistical significance. However, the surveillance group had a significantly lower fistula-related emergency admission rate (0.097 vs 0.381 per patient-year; rate ratio 0.259, p=0.001). No significant difference was observed in angioplasty rates between the two groups (0.443 vs 0.323 per patient-year; rate ratio 1.372, p=0.357). Conclusion: AVF surveillance was associated with a significantly reduced rate of fistula-related emergency hospital admissions. Although not statistically significant, observed trends toward lower thrombosis and access loss rates in the surveillance group suggest a potential protective effect. Angioplasty rates were comparable between groups. These findings support the role of surveillance in reducing acute healthcare utilization in hemodialysis patients.
