Background and Objective: Creating a reliable vascular access (VA) is the most important determinant for effective hemodialysis (HD). The ideal long-term VA is arterio-venous (AV) fistula. This study was undertaken to compare and determine the impact of timing of the AV fistula creation on its outcomes.
Subjects and Methods: In this interventional-comparative study a total of 168 ESRD patients referred by nephrologist for VA creation, to the vascular surgery clinic of Ahvaz Golestan Hospital from 1 Nov. to 31 May 2015-2016 were included in two 84-memberd groups. The late group in whom HD has been already started by double-lumen (DL) catheter and the early group in whom HD has not been started yet. they were followed prospectively and a complete data about their HD and VA were gathered.
Results: The mean duration of follow up was 16 ± 2 weeks. The incidence of complications was higher in late group (42 (50%) vs 22 (26.1%), P< 0.01). Non-maturing and thrombosis of fistula occurred more frequently in late group (34.5 % and 21.4 %) vs (8.3 % and 6%) respectively (P<0.01). Nearly all the deaths occurred in elderly patients with high incidence of major comorbidities.
Conclusion: Early placement of VA before HD start, except perhaps in elderly with multiple comorbidities, is reasonable and is associated with higher success rates. In addition, complications can be remedied without the need for catheter thus improving the survival of the VA and quality of life in ESRD patients.