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Author Topic: Fistulas First do all comers qualify.
Nathan
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Post Fistulas First do all comers qualify.
on: July 6, 2011, 21:13
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Patients seen by 2 nephrologist in the CKD phase of their renal disease have 20% decrease in having a catheter as there first access for HD. At what point in a patient's CKD would you go ahead and suggest the patient have a AVF or AVG placed to avoid a catheter?

Nathan
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Post Re: Fistulas First do all comers qualify.
on: July 8, 2011, 08:04
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Studies have shown that patients when referred to nephrologists for evaluation earlier in the course of CKD have better overall prognosis and survival.

Reasons include: better management of anemia, Bone-Mineral disease, CV risk factors and timely placement of access for dialysis or evaluation for transplant.

The recommendation is to get the patient ready by referring to a vascular surgeon for appropriate access (AVF or AVG, preferably AVF) at stage 4 CKD (GFR around 20 to 25 ml/min)
REF: (J Vasc Surg 2008;48:2S-25S.)

Although timely placement of access is favored, the debate as to when to start HD is still in question.

The current guidelines states to start HD with GFR falling below 10.
There are multiple investigations and studies stating early is better or late is better in various population group.
Certainly uremic symptoms take priority as to when to start HD.

Nirav Jasani
Nephrology Fellow

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