Terminal uremia and arteriovenous fistula patency.
One hundred and twenty-five arteriovenous fistulas for chronic hemodialysis are reviewed and their patency is related to the etiology of terminal uremia and other factors. A significant difference was found between the patency of fistulas of patients with chronic glomerulonephritis (CGN) and those of patients with chronic pyelonephritis (CPN). The average number of A-V fistulas in the CGN group was 1.30, while in those with CPN, 2.14 fistulas per patient necessitated construction. A pattern similar to that of the CGN group was observed in a third group of patients, who had an unclear diagnosis. The average number of fistulas was the same, and the mean survival 20 months in both groups, compared with the four months mean survival in the CPN group. Higher blood pressure levels were observed in the groups with a higher patency rate. The survival of patients with A-V fistulas appears to be related more directly to the etiology of the terminal uremia and care taken during hemodialysis than to the type of vascular connection. Anticoagulation and larger anastomoses are advisable in patients with increased risk of fistula deterioration. These patients should be included in the transplantation priority list.