ผลลัพธ์ของการผ่าตัดเชื่อมต่อหลอดเลือดแดงและหลอดเลือดดำ (Arteriovenous Fistula) สำหรับการฟอกเลือดในผู้ป่วยโรคไตวายระยะสุดท้าย: กรณีศึกษาในโรงพยาบาลกาฬสินธุ์

Kallaya Saejia; Yaowaret Kanmali; Picha  Konkanghana

doi:10.64960/srimedj.v41i4.271437

Authors

Kallaya Saejia Department of Surgery, Kalasin Hospital, Mueang District, Kalasin Province, Thailand 46000
Yaowaret Kanmali Nursing Research and Development, Kalasin Hospital, Mueang District, Kalasin Province, Thailand 46000
Picha Konkanghana School of Nursing, Sukhothai Thammathirat Open University, Pakkret District, Nonthaburi Province, Thailand 11120

DOI:

https://doi.org/10.64960/srimedj.v41i4.271437

Keywords:

arteriovenous fistula, end-stage renal disease, primary patency rate, secondary patency rate

Abstract

Background and objectives: Although arteriovenous fistula (AVF) creation is the stand method for vascular access in patients with end-stage renal disease (ESRD), evidence regarding outcomes and complications in provincial hotpital settings is still limited. This study aimed to evaluate AVF outcomes including primary/secondary patency rates, thrombosis, infection, stenosis requiring intervention, and CVC usage among ESRD patients at Kalasin Hospital.

Methods: This was a retrospective descriptive study using medical records of 156 ESRD patients who underwent AVF creation between October 2023 and September 2025.

Results: Mean age 58.4 ± 12.3 years; 54.5% male; diabetes 62.8%; hypertension 74.4%; radiocephalic AVF 58.3%. Maturation rate was 78.2%. Primary patency rates at 6 months, 1 year, and 2 years were 82.1%, 68.6%, and 54.3%; secondary patency rates were 91.7%, 83.3%, and 72.4%. Thrombosis 16.7%, infection 2.6%, significant stenosis 21.8%, CVC required 37.2%. Independent predictors of primary failure: female sex (OR = 2.14, 95%CI: 1.12-4.09, p = 0.021), diabetes (OR = 1.87, 95%CI: 1.03-3.40, p = 0.041), wrist AVF (OR = 2.43, 95%CI: 1.29-4.59, p = 0.006).

Conclusion: AVF outcomes at Kalasin Hospital were within acceptable international standards, with areas for improvement in reducing primary failure among female and diabetic patients through optimal surgical site selection.

References

Saran R, Robinson B, Abbott KC, Bragg-Gresham J, Chen X, Gipson D, et al. US Renal Data System 2019 annual data report: Epidemiology of kidney disease in the United States. Am J Kidney Dis 2020;75(1 Suppl 1):A6-A7. doi:10.1053/j.ajkd.2019.09.003.

The Nephrology Society of Thailand. Annual report 2023: statistics on renal replacement therapy in Thailand. Bangkok: The Nephrology Society of Thailand; 2024. [cited Jan 25, 2026]. Available from: https://www.nephrothai.org/

Lok CE, Huber TS, Lee T, Shenoy S, Yevzlin AS, Abreo K, et al. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis 2020;75(4 Suppl 2):S1-S164. doi:10.1053/j.ajkd.2019.12.001.

Tordoir J, Canaud B, Haage P, Konner K, Basci A, Fouque D, et al. EBPG on vascular access. Nephrol Dial Transplant 2007;22(Suppl 2):ii88-117. doi:10.1093/ndt/gfm021.

Dember LM, Beck GJ, Allon M, Delmez JA, Dixon BS, Greenberg A, et al. Effect of clopidogrel on early failure of arteriovenous fistulas for hemodialysis: a randomized controlled trial. JAMA 2008; 299(18):2164-71. doi:10.1001/jama.299.18.2164.

Al-Jaishi AA, Oliver MJ, Thomas SM, Lok CE, Zhang JC, Garg AX, et al. Patency rates of the arteriovenous fistula for hemodialysis: A systematic review and meta-analysis. Am J Kidney Dis 2014;63(3):464-78. doi:10.1053/j.ajkd.2013.08.023.

Robbin ML, Greene T, Allon M, Dember LM, Imrey PB, Cheung AK, et al. Prediction of arteriovenous fistula clinical maturation from postoperative ultrasound measurements: Findings from the Hemodialysis Fistula Maturation Study. J Am Soc Nephrol 2018;29(11):2735-44. doi:10.1681/ASN.2017111225.

Phirom K, Rerkasem A, Sitthisombat C, Maspakorn S, Taruangsri P, Pongtam S, et al. Arteriovenous fistula non-use: Insights from Thailand’s healthcare experience. J Vasc Access2026; 27(4):1553-64. doi:10.1177/11297298251396194.

Srivachirawat P, Lelamali K, Puavilai T. Prognostic factors of patency loss of arteriovenous fistula after percutaneous transluminal angioplasty. J Nephrol Soc Thail 2024;30(1):40-7.[cited Mar 15, 2025]. Available from: https://he01.tci-thaijo.org/index.php/JNST/article/view/267742

Lee T, Mokrzycki M, Moist L, Maya I, Vazquez M, Lok CE. Standardized definitions for hemodialysis vascular access. Semin Dial 2011;24(5):515-24. doi:10.1111/j.1525-139X.2011.00969.x.

Manns B, Tonelli M, Yilmaz S, Lee H, Laupland K, Klarenbach S, et al. Establishment and maintenance of vascular access in incident hemodialysis patients: A prospective cost analysis. J Am Soc Nephrol 2005;16(1):201-9. doi:10.1681/ASN.2004050355.

Dixon BS, Novak L, Fangman J. Hemodialysis vascular access survival: Upper-arm native arteriovenous fistula. Am J Kidney Dis 2002;39(1):92-101. doi:10.1053/ajkd.2002.29886.

Tessitore N, Mansueto G, Bedogna V, Lipari G, Poli A, Gammaro L, et al. A prospective controlled trial on effect of percutaneous transluminal angioplasty on functioning arteriovenous fistulae survival. J Am Soc Nephrol 2003;14(6):1623-7. doi: 10.1097/01.asn.0000069218.31647.39.

Al-Solaih Y, Estrada E, Allon M. The spectrum of infections in catheter-dependent hemodialysis patients. Clin J Am Soc Nephrol 2011;6(9):2247-52. doi:10.2215/CJN.03900411.

Beathard GA, Lok CE, Glickman MH, Al-Jaishi AA, Bednarski D, Cull DL, et al. Definitions and end points for interventional studies for arteriovenous dialysis access. Clin J Am Soc Nephrol 2018;13(3):501-12. doi:10.2215/CJN.11531116.

Kazemzadeh GH, Modaghegh MHS, Ravari H, Daliri M, Hoseini L, Nateghi M. Primary patency rate of native AV fistula: Long term follow up. Int J Clin Exp Med 2012;5(2):173-8. [cited Mar 15, 2025]. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3342707/

Vachharajani TJ, Moist LM, Glickman MH, Vazquez MA, Polkinghorne KR, Lok CE, et al. Elderly patients with CKD - dilemmas in dialysis therapy and vascular access. Nat Rev Nephrol 2014;10(2):116-22. doi:10.1038/nrneph.2013.256.

Huber TS, Ozaki CK, Flynn TC, Lee WA, Berceli SA, Hirneise CM, et al. Prospective validation of an algorithm to maximize native arteriovenous fistulae for chronic hemodialysis access. J Vasc Surg 2002;36(3):452-9. doi:10.1067/mva.2002.127342.