Complication, patency and incidence rates of first-time vascular dialysis access fashioned in Malta

Abstract

Background: The aim of the study was to assess first-time arteriovenous fistulae (AVFs) and grafts fashioned over a 5 year period in Malta, and analyse their patency and complication rates. The study also investigates compliance with Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines for fistula incidence. ---

Methods: Patients who underwent surgery between January 1st 2012 and December 31st 2016 were identified through the vascular surgery database at Mater Dei Hospital - Malta and followed up until 31st December 2017. Complications, interventions and patency duration were recorded from patient notes. Patency rates were calculated with Kaplan-Meier curves and log-rank test was used to compare significance between the curves. ---

Results: A total of 258 vascular access (VA) procedures were analysed, only 242 of which were used for haemodialysis. The chance of a VA developing no complications was 38%, with stenosis and thrombosis rates of 36.8% and 24.8% respectively. There was no significant difference between the complication rates or intervention frequency when comparing different fistula types. Of the 207 patients who had AVFs created since January 2012, only 26.1% (n=54) had creation prior to initiation of haemodialysis. Primary patency survival rates for first-time AVFs were 58.7±7.1% at 1 year and 48.1±7.4% at 2 years. The assisted primary rates were 73.7±6.3% at 1 year and 67.6±6.9% at 2 years. The secondary patency rates were 76.4±6.1% (95% CI, 70.3%-82.5%) at 1 year and 70.8 ±6.9% at 2 years. There was no significant difference when comparing primary (p=0.539), assisted primary (p=0.634) or secondary patency (p=0.783) rates for the different AVF types. ---

Conclusion: In Malta, AVF incidence lags behind the European average of 66%, but patency rates compare favorably with most other countries.