Technique is underutilized in the U.S., expert says
A new study finds that people with chronic kidney disease, whether young or old, respond equally well to dialysis done through arteriovenous (AV) fistulas, surgically created passageways between veins and arteries to help in the circulation of filtered blood.
In calling AV fistulas the “gold standard of access for kidney dialysis patients,” one of the study’s authors said the findings show that the pathways last longer, require less repair work, and are linked to lower rates of infections, hospitalization and death than other types of dialysis.
“AV fistulas are underutilized in the United States, yet they are best for keeping blood vessels open for access so individuals can continue to get their lifesaving dialysis,” Dr. Andrew R. Forauer, an interventional radiologist at Dartmouth-Hitchcock Medical Center in Lebanon, N.H., said in a news release from the Society of Interventional Radiology. Forauer’s findings were presented Monday in San Diego during the society’s annual meeting.
When a person’s kidneys fail, a dialysis machine takes over for the damaged organs, filtering wastes and extra fluids from the blood and then returning the clean blood to the body.
An AV fistula provides an access way for the blood to get in and out, with surgeons joining a vein and an artery in the forearm so that blood from the artery can flow into the vein. The increased blood flow makes the vein grow larger and stronger so it can be used for repeated needle insertions, providing an efficient pathway for the blood before and after treatment.
In the United States, however, many of those with chronic kidney failure instead have dialysis done with the blood passing in and out through synthetic bridge grafts, which Forauer said tend to clot or malfunction, increasing discomfort, inconvenience, and even death rates for dialysis patients.
In a study involving 72 people, half older than 75 and the rest between 40 and 60, the researchers found that the AV fistulas retained the same patency, or openness, in each age group.
“Elderly patients’ arteriovenous (AV) fistulas responded just as well as those in younger patients in length of time the access stayed open and in moving blood flow efficiently,” Forauer said. “An AV fistula is the preferred access at any age.”
An estimated 27 million people in the United States have chronic kidney disease. About 500,000 are being treated for kidney failure, which requires dialysis up to three times a week or a kidney transplant to live.