When should someone get an AV fistula for hemodialysis?

Question

Hello doctor,

My husband has been diabetic for the past many years and has been on insulin from the first day. Now he has been diagnosed with chronic kidney disease. He is hospitalized. His creatinine and blood sugar levels are also high. Dialysis was done four times last week. The doctor is asking him to go for an AV fistula on the left arm. But he is not willing. Does he need an AV fistula in his arms? I need a second opinion about this.

Kindly answer.

Answer 1

Hello,

Welcome to icliniq.com.

Your husband is suffering from chronic kidney disease, secondary to diabetic nephropathy (due to long-standing diabetes mellitus). Since his blood sugar levels were not under control all these years, they have damaged the kidneys and it is irreversible.

I suggest you two options.

1) Continue dialysis lifelong - The best vascular access for long-term dialysis are

1) Av fistula.

2) Permanent tunneled catheters either in the neck or leg.

2) Renal transplantation - This surgery requires a voluntary renal donor from the family who must be above 18 years and less than 65 years of age. If a proper donor is identified, it will take a minimum of three months for all workups. Undergoing renal transplantation will make him live his old life for at least another 15 to 20 years, but he has to stay on medications lifelong.

I suggest you continue his hemodialysis. Also, strictly monitor his blood sugars and modify dosage to bring them down.

Hope it helps.

Thanks and regards.