If you’re living with advanced kidney disease, preparing for dialysis can feel overwhelming. One crucial decision is how your blood will be accessed for treatment. While there are different options, one stands out as the safest and most effective, an Arteriovenous (AV) fistula. But what makes this surgical connection between an artery and a vein the gold standard for dialysis access? And how does it impact long-term treatment?
We spoke to Dr Hardik Patel, Consultant Nephrologist and Transplant Physician, Manipal Hospital, Goa, who explained why an AV fistula is preferred over other options and how it helps improve the dialysis experience.
Why Is AV Fistula Better for Dialysis Access?
"As kidney function worsens to the point of failure, hemodialysis is needed to filter waste and excess fluid from the body. To successfully perform dialysis, a consistent way of accessing the circulatory system is essential. The AV fistula, a surgically constructed link between an artery and a vein, is the gold standard of dialysis access," explained Dr Patel.
An AV fistula is used over other alternatives, such as catheters or artificial grafts, since it uses the patient's veins, lowering the risk of infection, clotting, and other complications. It is, therefore, a safer and longer-lasting option for long-term dialysis treatment. As reported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), in 2021, 12.2% of individuals utilised an AV fistula as their access point, whereas 85.4% relied on a catheter.
The AV Fistula Procedure and Its Benefits
The development of an AV fistula involves a simple outpatient surgery, generally performed under local anaesthesia. According to Yale Medicine, to begin the dialysis process, a nurse inserts two needles into the AV fistula. One needle draws blood from the body and sends it to the machine for filtration, while the other returns the cleansed blood to the body. Each dialysis session usually lasts between 3-4 hours, and most patients require three sessions each week.
"After the operation, it takes time for the fistula to mature, usually 4-6 weeks, allowing the vein to strengthen and accommodate the increased blood supply from the artery. Exercises for the hand, such as squeezing a rubber ball, can help speed up this process," said Dr Patel.
Once healed, the AV fistula forms reliable dialysis access, with smooth blood flow during dialysis treatments. Under proper management, it will last many years. The patient should check daily for any complications, like redness or swelling, or change in the 'thrill' (vibration over the fistula), and have regular check-ups with his or her physician to identify and treat any arising problems in the early stages.
Also Read: Why Regular Screenings Are A Must For Patients Undergoing Dialysis
Planning for an Improved Dialysis Experience
"For patients with advanced Chronic Kidney Disease (CKD), planning is important. Ideally, an AV fistula should be placed months in advance of when dialysis will be required, giving ample time for it to mature. Planning in this way prevents temporary catheter usage, which has greater risks of infection and other complications," added Dr Patel.
Bottomline
Dr Patel concluded, "Proper care of dialysis access is vital for maintaining overall health and well-being. Patients and families need to remain educated about their choices and collaborate with healthcare professionals to maximise outcomes."
[Disclaimer: This article contains information provided by an expert and is for informational purposes only. Hence, we advise you to consult your professional if you are dealing with any health issue to avoid complications.]