Unavailability of AV fistulas at the initiation of haemodialysis in Pakistan- limitations and implications

Aim: to evaluate the possible factors behind unavailability of av fistulas when there is a need of haemodialysis in chronic kidney disease patients in pakistan. methods: one hundred consecutive ckd patients presenting for haemodialysis through outpatients and emergency departments during a period of three months (march 2011 to may 2011) were included in this study. patients were interviewed according to a standardised questionnaire. results: the demographic characteristics revealed there were 52(52%) male patients and 48(48%) female patients (with mean age of 34.2 years). 34% patients were diabetics and 46% patients had chronic hypertension. none of the patients had avf at the time of initiation of haemodialysis. thirty six (36%) patients were advised to get the avf but they refused the surgery even having prior knowledge of ckd. thirty one (31%) patients were not aware of their pre-existing progressive renal disease. although ten (10%) patients had prior knowledge of their kidney disease but they were not referred to a nephrologist or vascular surgeon for avf. eight (8%) patients did not have availability of surgeon trained in vascular access creation. seven (7%) patients mentioned poverty of resources. six (6%) patients had unsuccessful avf surgery. only two (2%) patients presented with presumed arf. they received dialysis through temporary catheter and did not get avf for 3 months in hope of recovery. conclusion: in this study the two most frequent reasons for unavailability of av fistulas were refusal on the part of patient to permanent vascular access despite progressive ckd and the presence of advanced ckd (stage 5) without having a prior knowledge of their kidney disease. both issues highlight the lack of public awareness and health education and also underscore the importance of robust efforts on the part of medical community and health authorities to educate the masses about kidney disease. in this context,both are modifiable risk factors that would help maximise avfs and minimise access associated morbidity.