Factors Associated with Arteriovenous Fistula Maturation Failure among Patients Undergoing Hemodialysis in Hospitals Based in a Low and Middle-Income Country

IntroductionThe demand for haemodialysis among patients with end stage renal disease (ESRD) is rising worldwide, arteriovenous fistulas (AVF) are considered the gold standard vascular access modality for hemodialysis (HD) because of its longer patency, enhanced durability, and reduced risk of infection for those that mature compared to grafts and central venous catheters. This study will therefore assess the factors associated with arteriovenous fistula maturation for patients requiring hemodialysis in Dar es Salaam. MethodsA multi-centre based prospective study conducted among patients with ESRD between April 2021 to May 2022 at Muhimbili National Hospital (MNH), Jakaya Kikwete Cardiac Institute (JKCI), Comprehensive Community Based Rehabilitation in Tanzania (CCBRT),Kairuki hospital (KH) in Dar es Salaam. Patients with End stage renal disease eligible for arteriovenous fistula (AVF) creation and Hemodialysis were included. Socio-demographic data were extracted from the patients, intraoperative and postoperative variables were obtained from medical records. Patients were assessed through eight weeks for maturation and complications. Data analyzed accordingly by IBM-SPSS version 27.0, Univariate and multivariate analysis were used to stratify the factors and control the confounders for the effects on outcome, and p-value of <5% was used to state the level of significance at 95% CI. ResultsTotal of 151 fistulas were created, most (80.8%) were created on male, (31.8%) in the age group of less than 50 Years old, 58.9% of the participants had normal Body Mass Index (BMI), with majority (45%) being suffered from Hypertension and 54% of them were using Antihypertensive medication. Brachial cephalic fistulas were the most common type of fistula created 77(51%) and most matured 67(52.7%) among ESRD patients who had AVF creation, while radial cephalic fistulas were the most failed created AVFs 13 (54%). The AVF maturation failure rate was 16%. ConculusionFailure of newly created AVF is a major barrier to the successful establishment of hemodialysis access, in this study the failure rate of AVF maturation was 16 percent. The major factors associated with failure to mature were; extreme age group (50-59), being suffered with both hypertension and diabetes, long period of alcohol taking and distal location of AVF(radiocephalic fistula).Vascular imaging was not regularly done to assess the status of veins and arteries for AVF creation.