Arteriovenous graft/fistula (AVG/AVF) is a surgical procedure where the vein is connected directly to the artery either in the lower forearm or at the elbow to facilitate hemodialysis.
- Creation of an arteriovenous fistula could be beneficial for
patients with chronic kidney disease (CKD)
- Decline in estimated Glomerular Filtration Rate (eGFR) is slow
after the surgery
- A new study finds that arteriovenous graft/fistula slows renal
decline irrespective of the status of fistula maturity.
The procedure is done to increase the flow of blood through the vein so that it can be directed to the hemodialysis
machine to enable the exchange of fluids and toxic chemicals in the blood. These specially created veins are able to withstand the pressure of suction that is exerted by the dialysis machine, otherwise, the veins would collapse like a straw.
This surgical procedure if done before the patient's
kidney function declines completely, is found to slow down renal decline in
This interesting observation on
chronic kidney disease patient was made by Keiichi Sumida and colleagues from
The University of Tennessee Health Science Center in Memphis.
About Arteriovenous Fistula (AVF) &
Arteriovenous Graft (AVG)
Arteriovenous Fistula (AVF) Access for hemodialysis has certain advantages that include:
Grafts are used when there is no suitable vein available.
- Lower chances of infection
- Better flow of blood for
- This access stays longer that
other forms of access
For Arteriovenous Graft (AVG) surgery an
artificial tube made of Dacron or PTFE is usedas a loop to
connect an artery to a vein. This looped graft is the used to transfer blood
‘Arteriovenous fistula surgery slows down decline of kidney function in patients with chronic kidney disease and delays start of dialysis.’
The AVG should
be well cared for as there is a higher risk of infection and for the
development of blood clots but if it is looked after cautiously, it can be used
for many years.
Both the AVG and
AVF are routine surgical procedures that are carried out as outpatient
procedures or may require an overnight stay at the
The current study by Keiichi Sumida and colleagues notes that the benefits of these surgical procedures may well extend beyond just facilitating hemodialysis and they may actually delay the renal decline. This study entitled "Association between vascular access creation and deceleration of estimated glomerular filtration rate decline in late-stage chronic kidney disease
patients transitioning to end-stage renal disease
" has been published in the Journal Nephrology, Dialysis, Transplantation
AVF and eGFR
An earlier study
by Golper TA and colleagues from the Vanderbilt Center for Kidney Disease
studied the effect of AVF on estimated glomerular filtration rate (eGFR) in a
study titled "Arteriovenous fistula creation may slow estimated glomerular
filtration rate trajectory." and published in the Journal Nephrology, Dialysis,
Transplantation (Dec 2015).
A retrospective study was conducted on 123 chronic kidney disease patients between the years 2005 and 2010. Patients whose fistula showed maturation were included in the study and the study was terminated in the event of death, transplantation of kidney
or if dialysis is started for the patient.
This study found
that AVF lowered eGFR rate, but since it was a
retrospective study, no conclusion could be drawn from the study.
AVF/AVG And eGFR Vs Confounding Factors
creation of AVF/AVG were found to improve eGFR, it wasn't determined if it was
due to the constitution of a mature access to the circulatory system or if it
was due to confounding factors. Keiichi Sumida and colleagues studied 3026 US
veterans with chronic kidney disease who had pre-dialysis AVG/AVF surgical
procedure between 2007 and 2010 and were included in the study. Time-dependent and fixed confounders were adjusted and the eGFR slopes
who did not have AVF/AVG and underwent dialysis during the same time period
were used as controls. The eGFR slopes
of the patients under study showed a decline in patients who underwent AVG/AVF
procedure and a delay in requiring dialysis among advanced chronic kidney
patients, indicating a stall in renal decline.
The study concluded that creation of a surgical
fistula between the artery and vein in a patient with chronic kidney disease
actually lowers advancement of kidney disease, prolonging the pre-dialysis
period and postponing the need for hemodialysis.
- Sumida K, Molnar, Potukuchi PK, Thomas F, Lu,Ravel VA, Soohoo M, Rhee CM, Streja E, Yamagata K, Kalantar-Zadeh K, Kovesdy CP. "Association between vascular access creation and deceleration of estimated glomerular filtration rate decline in late-stage chronic kidney disease patients transitioning to end-stage renal disease." Nephrol,Dial,Transplant May 2016
- Golper TA, Hartle PM, Bian A, "Arteriovenous fistula creation may slow estimated glomerular filtration rate trajectory." Nephrol,Dial,Transplant Dec 2015
- Vascular Access for Hemodialysis