Comparing the durability of fistula and graft in renal failure patients on haemodialysis

Abstract

Brief overview of the topic: It is evident that the global population is facing an increased rate in chronic kidney disease which often leads to renal failure. Most of these patients are treated with haemodialysis, after identifying a good vein for such treatment. This process involves a small procedure performed by a surgeon applying either a fistula or graft. The aim of this dissertation is to analyse and compare which of the fistula or graft are more durable when used in long-term renal failure patients. Research question: ‘In patients with renal failure on haemodialysis, is fistula compared to graft more durable? PICO Elements: Population (P): Patient with renal failure haemodialysis, Interventions (I): Fistulas, Compare (C): Grafts, Outcome (O): More durable. Methods: Using Boolean operators as well as limiters, a search method was devised. Additionally, a manual search was conducted by accessing several databases being HyDi, Science Direct, PubMed, and World Cat. This allowed for more comprehensive research. To identify and reject non-essential publications the PRISMA 2009 checklist was utilised. Moreover, to further assess the articles’ eligibility, a set of inclusion and exclusion criteria was created. The articles used were written in the English language, peer review, and a maximum of 10-year-old. Studies retrieved included End-Stage renal failure elderly patients who were using haemodialysis and compared fistula and graft durability in the long term. Other studies containing different populations as well as outcomes were excluded. To answer the PICO question, the best eight evidence-based-practice articles were identified: consisting of two Randomised control trials (RCTs) and six Cohort studies. The articles were critically appraised through the CASP tools. Results: All eight articles have statistically shown that depending on the patient’s comorbidities and life expectancy fistulas are the most preferred vascular access due to their durability when matured. Conclusion: Articles concluded that although fistula has a better patency and less infections, comorbidities and life expectancy must be taken into consideration. Implication and recommendations: Only one local study was found, and it included limited sample size which calls for a larger sample size to identify durability of the fistula in the Maltese population. Future research conducted through RCTs is the golden standard in providing solid evidence efficacy and accuracy.