Use of AV Fistula/Graft in End Stage Renal Disease Patients Receiving Continuous Renal Replacement Therapy.

Background: Continuous renal replacement therapy (CRRT) is used frequently in end stage renal disease (ESRD) patients with multi-organ failure in a critical care setting. We report our experience using pre-existing functioning AV fistula/graft as an access in ESRD patients requiring CRRT. Methods: AV fistula/graft was used as an access in all 27 patients (15 males, 12 females; 23 AV fistulas, 4 AV grafts; mean age 63, range 32-90 years) who required CRRT from May 2012 to September 2016. Policy and procedures were established before using AV access for CRRT. Dialysis nursing staff placed 16 gauge plastic angiocatheters in the AV access, connected using 30" extension tubing (secured with an anchor) to the arterial and venous tubing of M100 set with AN69 hemofilter, using Prisma/Prismaflex CRRT system. Angiocatheters were changed every 72 hours with the change of M100 set with AN69 hemofilter or earlier if CRRT was discontinued. Prismasate BGK 4/2.5 was delivered at 500-1000 ml/hr as a dialysate and Prismasol BGK2/0 or 4/0 was infused at 1500-2000 ml/hr as replacement fluid. All patients received citrate anticoagulation. Data were collected retrospectively. Results: The indication for CRRT included septic shock in 13 patients, hemorrhagic shock in 9 patients and cardiogenic shock in 5 patients. The mean blood flow rate was 137 ± 26 ml/min. Minimum effluent rate of 20-25 ml/kg/hour was achieved in each patient. The total duration on CRRT was 2040 hours over 97 days, with a mean duration of 21.3 hours/day. All AV accesses were functioning after the CRRT was discontinued. Thirteen patients survived and received intermittent HD using AV access without complications after CRRT was discontinued. No AV access bleeding, infection or technical problems were observed. Conclusions: Our experience suggests, that use of preexisting AV fistula or graft as an access with an angiocatheter (connected via an extension tube while secured with a tubing anchor) for CRRT can be used safely, and obviates the need for a double lumen catheter for an access and its potential complications. In addition, the use of AV access may keep fistula or graft patent in these ESRD patients. [ABSTRACT FROM AUTHOR]