Aims Arteriovenous fistula is considered as reliable form of vascular access for hemodialysis in Chronic Kidney Disease (CKD) patients. We aim to evaluate prospectively, the outcome and primary failure rate of Arteriovenous fistula in 30 Chronic kidney Disease patients with Glomerular Filtration Rate (GFR) <30ml/min. Materials and methods This prospective study was conducted at the department of cardiothoracic and vascular surgery (CTVS), College of Medical Sciences, Bharatpur from May 2011 to May 2012. Thirty patients ranging from age 25 to 76 years with stage IV and V CKD, i.e. GFR below 30ml/min, were included in this study. Detailed physical examination including arterial pulses i.e. axillary, brachial, radial and ulnar and blood pressure in both upper limbs was recorded. Allens test was performed on every patient and left upper limb was used for AV fistula formation. Brachiocephalic fistula was made in 19 (63.33%), while radiocephalic fistula was made in 11 (36.67%) patients. Patients were evaluated post operatively, on outdoor basis, weekly for 6weeks. All patients were evaluated for the presence or absence of complications i.e. infection, hematoma, thrombosis, aneurysms and steal syndrome. Results The complication was primary failure in two patients. One male patient got secondary infection and one female patient got post operative hematoma leading to 6.66% primary failure of fistula. No other complications were noted. Conclusion Arteriovenous fistula is the gold standard for vascular access for hemodialysis in patients with deteriorating renal function and end-stage renal disease. It is designed to improve the effectiveness of dialysis with fewer risks and complications than other vascular accesses. This study gives the higher success rate of 93.33% and concludes that age should not be a limiting factor when determining candidacy for arteriovenous fistula creation and is the safe procedure. Journal of College of Medical Sciences-Nepal, 2012, Vol-8, No-4, 1-6 DOI: http://dx.doi.org/10.3126/jcmsn.v8i4.8693

Patients with chronic kidney disease including renal transplant recipients (RTRs) have a markedly higher prevalence of cardiovascular disease than the general population. Many trials have established the role of statins in the prevention of cardiovascular mortality, not only by decreasing the low density lipoprotein-cholesterol levels but also by their pleotropic effects. These data from the general population may not be applicable to RTRs as these patients have different cardiovascular risk profiles. Till date, only a few prospective, randomized trials have assessed the use of statins in RTRs with regards to cardiovascular outcomes. The Assessment of Lescol in Renal Transplant trial, the largest trial so far, suggested that dyslipidemia management with statins in RTRs is associated with a significant reduction in the incidence of cardiac death and nonfatal myocardial infarction (although differences in the combined primary end point were not statistically significant). The current guidelines from National Kidney Foundation for managing dyslipidemia in RTRs recommend managing all chronic kidney disease patients as a coronary heart disease equivalent. The task group for drafting these guidelines concluded that based on the currently available evidence, additional studies may be needed in RTRs to confirm and extend the results of Assessment of Lescol in Renal Transplant trial.

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