Outcomes of Arteriovenous Fistula Under Cashless Government Scheme – A Pilot Experience from Public Sector Hospital from India

Background: Accessibility of vascular care services is not in proportion to the accessibility of dialysis services. “Vascular care to all’ is pivotal for sustainable dialysis program. In our state, both dialysis services and vascular care services are available free of cost to all poor and needy. However, the lack of experts and infrastructure remains a major challenge for equity of vascular care services. In our public sector hospital, we started the fistula program overcoming major challenges. We undertook this pilot study to assess the outcomes of the fistula program. Aim: We undertook this pilot study to assess the outcomes of the fistula program. This study aims to identify the factors that influence the outcomes of the creation of fistula and also the factors leading to primary fistula failure in a public sector hospital. Methodology: We prospectively followed up all patients admitted for creation of AV Fistula, for the outcomes at sequential intervals of 3 months, 6 months and 1 year. We assessed the primary patency, maturation, doppler assessment (baseline and periodic surveillance). Results: Only 10% of the 189 patients had stage 4 CKD, with the rest patients receiving dialysis via tunnelled (23%) and nontunnelled (76%).78% of patients underwent naive AVF, whereas the remaining patients underwent resecuring AVF. The surgery took an average of 70+20 minutes. The majority (57%) had brachiocephalic fistulas, while roughly 23% had radiocephalic fisrulas. Significant vascular alterations were seen, with diabetic patients having thinner arteries and women having thinner veins. Age, smoking, diabetes with kidney disease, and cardiovascular disease were the factors linked to primary failure of AVF, which we observed in 21% of cases. The main causes of primary AVF failure are older age groups, comorbidities of diabetes mellitus, heart disease, dyslipidaemia, and prior AVF failure. Conclusion: Vascular care and surveillance must be accessible and equitable in public sector dialysis programs. Vascular care success rates are comparable to those of other countries. The main causes of primary AVF failure are older age groups, comorbidities of diabetes mellitus, heart disease, dyslipidaemia, and prior AVF failure.