A RETROSPECTIVE REVIEW OF ARTERIOVENOUS FISTULA SURGERY AT THE KIDNEY FOUNDATION OF FIJI/CWMH (2008-2012)

Background: The internationally recommended vascular access for hemodialysis is Arteriovenous fistula (AVF). Since the inception of Kidney Foundation Unit of Fiji there have been efforts in the AVF use for our hemodialysis patients.
Aim: This study reviews the outcome of arterio-venous fistula (AVF) done at Colonial War
Memorial Hospital (CWMH) and factors that influence outcome of AVFs for hemo-dialysis patients at the Kidney Foundation Unit of Fiji (FKFU).
Method: A retrospective review carried out from 01st January, 2008 -31st December, 2012 on End Stage Kidney Stage patients with AVF created locally. Clinical Outcomes assessed included success and failure. Patient characteristics and factors that might have influenced the outcome were analysed.
Results: A total of 57 AVFs were created in 54 patients. This study revealed that we have 26% AVF use in Fiji. One third was diabetic and hypertensive. Out of the 57cases of AVFs, there were 40 (70%) successful cases and 17 (30%) failures. Younger patients «45years) had better outcome (p-O.039). All cases that failed were primary failure. The patency rate at within 12 months and more than 12 months was 36% and 21% respectively. Factors examined were categorised into pre-op, intra-op and post-op factors. Eighty five (85%) percent of patients were referred at late stage of End Stage of Kidney Disease (ESKD) hence reflected on less than 10% used AVF at initial dialysis. A median time of AVF formation is 90 days and mean of 100 days. Pre-op and post-op assessments were done in 35% and 20% respectively but there was no indication of any practical guidelines used by the surgeons. A common practice of early cannulation was noted in the hemodialysis unit (median =45days; mean = 30 days).
Conclusion: there is an acceptable success rate of AVFs in Fiji.
Keywords: Arteriovenous Fistula, End Stage Kidney Disease, Hemodialysis,