Dr RIZZA ANTOINETTE YAP SO-RUBIO1, Dr VIVIAN IMBRIOTIS1, Dr SHIRLEY CAI1, Dr VIKRAM PUTTASWAMY1, Dr ANIMESH SINGLA1, Dr EMMA O'LONE1,2
1Royal North Shore Hospital, Sydney, Australia, 2University of Sydney, Camperdown, Sydney, Australia
Biography:
Dr. Rizza Antoinette So trained in General Nephrology at the Royal North Shore Hospital (RNSH) in 2023 as an International Society of Nephrology Fellow. In 2024, she took on the role of Unaccredited Trainee in Research, focusing on vascular access surveillance and maintenance. She also worked on various research projects in the same field. She has since returned to the Philippines and has applied for a staff specialist position at the National Kidney and Transplant Institute (NKTI). Dr. So is eager to apply all the knowledge and experience she gained abroad and looks forward to future collaborative work with RNSH.
Aim:
To describe vascular access (VA) outcomes in patients planned for haemodialysis (HD) at a tertiary centre following implementation of a formal surveillance program.
Background:
While guidelines support VA surveillance, optimal surveillance strategies remain unclear. Reviewing VA data helps improve outcomes for our high-risk population.
Methods:
A single-centre retrospective study, including all patients with arteriovenous fistulas and grafts (AVFs/AVGs), was conducted between January 2022 and June 2024. Data collected included demographics, operative details, imaging, and antiplatelet use. AVF/AVG survival was analysed using Kaplan-Meier curves, and risk factors associated with patency were identified with Cox proportional hazards.
Results:
A total of 128 AVFs were created in 122 patients, with 76 (59.4%) being first-ever AVFs. Median intervention rate was 0.58 interventions per fistula year (IQR 1.79), and median primary patency was 106 days (IQR 164 days). Intervention risk peaked within the first 200 days post-creation. Pre-dialysis intervention was needed in 47% of AVFs, and 44.3% of patients required a central venous access device (CVAD) due to AVF immaturity. Overall, 52% of AVFs required surgical intervention pre- and post-dialysis. Diabetes and fistula location did not significantly influence intervention rates. However, antiplatelet agents at AVF creation had a two-fold increased intervention rate (adjusted IRR 2.08, 95% CI 1.16-3.81). Inflow arterial velocities below 50 cm/s were independently associated with higher intervention rates.
Conclusions:
Intervention rates remain high in our population, often necessitating CVAD use for dialysis initiation. Traditional risk factors like diabetes and age did not appear to be associated with increased intervention rates, but antiplatelet use, likely a surrogate marker for vasculopathy, did. Identified high-risk patients should be considered for earlier VA placement and appropriately counselled to manage expectations.