Getting the basics right: the monitoring of arteriovenous fistulae, a review of the evidence

Abstract

Purpose of review Despite being the preferred vascular access for haemodialysis, the arteriovenous fistula (AVF) remains prone to a number of complications, the most common of these being thrombosis secondary to stenosis. This has resulted in the widespread use of monitoring and surveillance programmes. Surveillance uses more resources than monitoring and has not been convincingly shown to improve outcomes. The evidence supporting the use of the various monitoring tools has been relatively neglected and has not been the focus of literature review. This narrative review is the first to appraise the evidence for the use of physical examination, access recirculation, Kt/V and dynamic venous pressures (DVP) as monitoring tools in mature AVF. Recent findings The vastly increased number of data points for access recirculation, Kt/V and DVP produced as standard by online clearance monitoring (OCM) on modern dialysis machines is likely to have significantly changed the utility of these metrics in the prediction of AVF failure. Algorithms have been developed to highlight those of highest risk of failure. Summary The evidence supporting the use of monitoring in the prediction of AVF failure is predominantly observational, underpowered and more than 20 years old. Access recirculation and Kt/V appears to have higher utility in AVF than in arteriovenous grafts. We suggest that the development of OCM necessitates the reevaluation of these tools.

Frequency of Dysfunctional Arteriovenous Fistula among End Stage Renal Disease Patients on Thrice Weekly Maintenance Hemodialysis

“…Complications of AVF were classified into Inflow stenosis, outflow stenosis, aneurysm, thrombosis, infection, and steal syndrome. 11 The collected data were entered and analyzed in SPSS-23. Data were stratified for age, gender, duration of dialysis via the AVF, to deal with the effect modifiers.…”