POS-630 RELIABILITY OF NEPHROLOGIST LED CLINICAL ASSESSMENT FOR VASCULAR ACCESS CREATION

ABSTRACT

Introduction: Arteriovenous fistula (AVF) delivers the best treatment dose prescribed for hemodialysis. KDOQI guideline 2006 advocate the adoption of ultrasound mapping for pre access creation. However, this is not translated to routine practice due to scarce resources. In this study, we wish to study the efficiency of clinical assessment in determining the suitable vessels for AVF creation and the access survival. Methods: This is a single tertiary nephrology center, prospective study of a series of patients who were referred to our AVF outsource program that was funded by Ministry of Health. This program diverting non Covid-19 CKD 5 or new ESKD patients that have opted for hemodialysis to private facilities for AVF creation due to the limitation of available operating theatre slot in government hospital attributed by Covid-19 pandemic. Those assessed by our nephrologists and trainees in a specially created outsourcing clinic that deemed suitable for assess creation will be outsource to the private institutions. Clinician assessment of suitability of the vessels and the outcome of AVF creations at 6 months were captured and analyzed. Results: A total of 147 patients were identified, reviewed, and outsourced, with the mean age of 54-year-old, male predominant (n 94). 65% of the cohort has diabetes mellitus as their primary disease followed by hypertension at 17%. 37.4% of the cohort are CKD 5 patients who are not on dialysis, while 10.8% on peritoneal dialysis and 51.7% were on hemodialysis. 87% of the patients were AVF naïve whereas 13% had prior history of failed AVF. Out these, 15.6% of patients did not have access created (1 passed away, 7 needed complex grafts, 13 have small vessels, 2 needed two stages surgeries). Of the remaining 124 patients (84.4%), 2 received AVGs and 122 received AVFs. From the first subsequent vascular review by the surgeons, the concordance for the vascular access creation suitability with our assessment was 91.1%. Subsequently, the concordance for vascular access that was successfully created was 84.3% with site of creation agreement at 61%. At 6 months post AV access creation, 13 patients (10.5%) have primary failures whereas 11 patients (9%) had secondary failure. 21 patients (17%) unfortunately passed away during the study period and were excluded. At 6 months, 60% of the patients have functional AV access. In addition, for the 26 patients that have deemed no suitable vessels for AV access creation from prior vascular review before referred to our program, 84.6% has AV access created subsequently. Their outcome in 6 months includes 36.3% have functional AV access, 18% have primary failure, 22.7% have secondary failure and another 22.7% passed away. Conclusions: We have demonstrated a careful clinical assessment of a patient’s vascular access by a nephrologist led team provides a high and consistent level of accuracy as to successfulness of the vascular creation. The omittance of routine vascular mapping in our protocol provide considerable cost and time saving which echoes the latest guideline by KDOQI 2019. Patients who failed assessment prior still warrant a repeat clinical assessment if they are considering hemodialysis as the life plan of kidney replacement therapy. No conflict of interest