FISTULA FIRST INITIATIVE

INCIDENCE AND BARRIERS IN FOLLOWING THE PROTOCOL FOR AV FISTULA FOR DIALYSIS.

Abstract

Background: Although AV fistula is considered as a gold standard for initiating
hemodialysis in patients with ESRD, the incidence is quite low in our population. Aim: The
aim of this study is to find out the incidence of permanent AV access i.e. AV fistula at the time
of first dialysis and causes leading to failure of this protocol. Study Design: Cross-sectional
study. Setting: Hemodialysis unit of Lahore General Hospital. Period: August-September,
2017. Method: Patients undergoing hemodialysis in dialysis center of Lahore General
Hospital. Results: Out of 82 patients recruited, only 4 patients were found to have their first
hemodialysis with AV fistula, remaining 78 patients had temporary double lumen catheter for
emergency hemodialysis who were later on counselled to have AV fistula. Reasons include lack
of counselling/awareness/education of disease in patients 71.79%, emergency HD in patients
with hypertensive emergencies 14.1%, and delay in maturation (7.6%) and failure (6.4%) of
AV fistula. Conclusion: To increase the incidence of fistula first initiative integration of different
professional teams are required as well as education and awareness should be instilled in
patients to help them in taking decisions.