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Patients who had arterio-venous fistula insertion and attended the low clearance clinic

How is the Trust doing?

The Trust is aiming for a high standard of at least 80% of patients to have an arterio-venous fistula created before starting haemodialysis.

It is however recognised that not all patients will be able to have an arterio-venous fistula created before starting haemodialysis for various reasons including: difficulty in predicting the start of haemodialysis and patients choosing not to have a fistula despite counselling.

Why is this indicator important?

The current UK Renal Association guidelines recommend that all patients choosing haemodialysis should have a fistula created between 3-12 months before starting dialysis. There are major advantages to dialysing through a fistula including that there is no plastic to get infected and the quality of dialysis is much higher. Patients who start haemodialysis with a working fistula do a lot better in terms of fewer hospital admissions and survival than those who do not.

Further Information

Patients with established (permanent) kidney failure enter the Trust’s chronic dialysis programme. UHB is one of the largest dialysis centres in the world with over 1000 patients currently on the dialysis programme.

Haemodialysis is a method for removing waste products as well as water from the blood in severe kidney failure. The main challenge with this technique is getting the blood from the patient to pass through a filter before being returned. There are two main ways of doing this via a dialysis line or an arterio-venous fistula which is the preferred way of providing dialysis. This is a large vein made by directly linking an artery to a vein, usually at the wrist or elbow, as a minor operation.

Patients whose kidneys are failing attend a specialist clinic at UHB called the low clearance clinic. In this clinic patients are given a lot of information about the choices available to them and if they choose dialysis they will then be physically prepared for it, including creation of a fistula if appropriate.

How do we measure this indicator?

All patients who started haemodialysis and had also been attending the low clearance clinic for up to three months before this. Three months is the very minimum period required to counsel a patient and schedule fistula surgery. The operation records are then checked to see whether these patients had had an arterio-venous fistula created beforehand.