key: cord-0944200-2cjuigd1
authors: Mahapatra, Himansu Sekhar; Binoy, Renju; Inamdar, Neeraj Anant; D P, Kushal; Kumar, Adarsh; Kaur, Navjot; Singh, Mansi; Kumari, Anamika; Krishna, Chandra; Balkrishna, Muthukumar; Pursnani, Lalit
title: Continuing arteriovenous fistula creation by nephrologist and its outcome during COVID pandemic—Analysis of 376 cases
date: 2021-09-08
journal: Semin Dial
DOI: 10.1111/sdi.13010
sha: 008866a2e523c8e4929436b5ec32be1bdbe5fd82
doc_id: 944200
cord_uid: 2cjuigd1

There has been a significant reduction of elective surgeries including creation of arteriovenous fistulas (AVF) during the ongoing pandemic by the surgeons. Here, we report the retrospective observational data of AVF creation by nephrologists in a single center, during a period of 8 months. A total of 376 fistulae were created in 310 patients. Patients were followed up at 2, 6, and 12 weeks. Twenty‐eight patients required fistula creation twice, 16 patients thrice, and two patients underwent fistula creation four times. Of the total, 259 (68.8%) fistulae were radio‐cephalic while 99 (26.3%) and 18 (4.79%) were brachio‐cephalic and brachio‐basilic, respectively. A total of 207 (67%) patients were already on hemodialysis whereas 103 (33%) were planned for elective initiation after fistula maturation. Of the 211 (69%) patients who completed 3 months of follow‐up, 31 (15%) expired and 7 (3.3%) were lost to follow‐up. Primary failure was observed in 70 (33.2%) fistulae. Fifteen (7.1%) patients were noted to be COVID positive during the follow‐up. A total of 279 (90%) patients were alive at last follow‐up. Amongst 20 dialysis staffs with 10 nephrologists, only two have developed COVID. Both were having mild illness and recovered completely. This study demonstrates that AVF creation can be performed safely with careful screening and by using adequate personal protective equipment.

required fistula creation twice, 16 patients thrice, and two patients underwent fistula creation four times. Of the total, 259 (68.8%) fistulae were radio-cephalic while 99 (26.3%) and 18 (4.79%) were brachio-cephalic and brachio-basilic, respectively. A total of 207 (67%) patients were already on hemodialysis whereas 103 (33%) were planned for elective initiation after fistula maturation. Of the 211 (69%) patients who completed 3 months of follow-up, 31 (15%) expired and 7 (3.3%) were lost to followup. Primary failure was observed in 70 (33.2%) fistulae. Fifteen (7.1%) patients were noted to be COVID positive during the follow-up. A total of 279 (90%) patients were alive at last follow-up. Amongst 20 dialysis staffs with 10 nephrologists, only two have developed COVID. Both were having mild illness and recovered completely.

This study demonstrates that AVF creation can be performed safely with careful screening and by using adequate personal protective equipment.

There has been a significant reduction in elective surgeries including creation of arteriovenous fistulas (AVF) during the COVID-19 pandemic. Here, we report the retrospective data of AVF creation by nephrologist, during a period of 8 months from 1st March 2020 to 31st October 2020. AVF creation is the cost-effective modality of vascular access compared to arteriovenous graft (AVG) or central venous catheter (CVC). AVF creation is safe and is not associated with increase in failure rate with COVID infection. Furthermore, due to low socio-economic status, non-tunneled catheters are performed more compared to tunneled catheters which in turn may lead to increased catheter-related complications where the COVID pandemic is ongoing >1.5 years.

Amongst hospitalized COVID-19 hemodialysis patients, mortality is observed to be 30%. 5 This is the largest experience of AVF creation by nephrologists which is not associated with significant hazards to healthcare workers or patients if done with strict screening using adequate personal protective equipment (PPEs). Hence, nephrologists need to continue creating AVF during these adverse situations. Similar to non-COVID period, involvement of vascular surgeons, cardiologists, and interventional radiologists is also essential in decreasing the primary failure rate.

Himansu Sekhar Mahapatra https://orcid.org/0000-0002-2345-

Mansi Singh https://orcid.org/0000-0003-2168-263X

Aggressive treatment of early fistula failure

Clinical practice guidelines for hemodialysis adequacy, update

Improved outcomes with proximal radial-cephalic arteriovenous fistulas compared with brachialcephalic arteriovenous fistulas

March 24 O, 2020COVID-19 Guidelines for Triage of Vascular Surgery Patients. American College of Surgeons

Treatment impact on COVID-19 evolution in hemodialysis patients

Associations between hemodialysis access type and clinical outcomes: a systematic review

Continuing arteriovenous fistula creation by nephrologist and its outcome during COVID pandemic-Analysis of 376 cases