Category Archives: AV Fistula

Hello. I’m male aged 56 years old. I have creatinine value 5, eGFR value 15 and am NOT on dialysis. I intend to go for renal transplant but came to know that I need angiography. My question is should I get a fistula made before the procedure? Also is there some form of angiography for CKD patients which does not (or at least reduces) risk further deterioration of my kidneys?

All forms of contrast used for angiography is potentially toxic to patients with advanced chronic kidney disease (CKD). There is no safe dye (contrast). You should discuss the placement of a fistula with your nephrologist and also seek guidance as … Continue reading

Posted in Ask the Doctor, AV Fistula, Chronic Kidney Disease, Kidney-Related Health Questions, Nephrologist

My daughter is on hemodialysis for almost 8 months now and is using an internal jugular (IJ) catheter as access. Her arteriovenous (AV) fistula, created 7 months ago, could not be used yet as the venous part is still deep. The doctor in the dialysis center suggest that we use the arterial part of the AV fistula and the venous port of the catheter to improve the dialysis dose (currently at 1.15 using Lowrie formula and 1.31 using Daugirdas’). Is this possible? Will the suggested procedure ruin the AV fistula as a whole? Thank you.

Using the fistula for arterial access and the catheter for venous access is a common tactic used to develop the fistula for use. The catheter is always subject to some recirculation of blood in the dialysis machine. This means that … Continue reading

Posted in Ask the Doctor, AV Fistula, Dialysis, Kidney-Related Health Questions

My sister has no kidneys and her last port got a staph infection so they want to do a (Lumbar dialysis access). Can you tell me what that is and where would they put the fistula. Thank you.

A lumbar dialysis access is a catheter that is surgically placed into a large vein, called the inferior vena cava, that has to be accessed through the back (lumbar area). This is not a fistula but rather a catheter access … Continue reading

Posted in Ask the Doctor, AV Fistula, Dialysis, Kidney-Related Health Questions

I have been swollen on my left side since fistula formed June 2014. The second part is finally done November 2016. Since February 2017, I started to get numb in my left arm. It was swollen to approx 4 times in size and I have been given an elastic sleeve to squash fluid out. I have had bad dialysis for 3 1/2 years now. My doctors do not know why I am swollen. I would appreciate any advice on how to stop swelling and what I can do?

I am unable to make a specific diagnosis based on the information that you present. I suspect that you have a blockage to your fistula either in your shoulder or your chest that is causing the arm to swell. The … Continue reading

Posted in Ask the Doctor, AV Fistula, Dialysis, Kidney-Related Health Questions

My mom has been on dialysis for over 5 years. She has 4 to 5 aneurysms in her arm. Is this possible with just 1 fistula in her arm?

The aneurysms of a fistula are related to repeated needle puncture of the skin and vein of the fistula.  This creates weakness or thinning in the wall of the fistula and the skin.  This tends to create the aneurysms that … Continue reading

Posted in Ask the Doctor, AV Fistula, Dialysis, Kidney-Related Health Questions, Symptoms and Side Effects

Can you place a tunneled central venous catheter on the same side as an AVF? I understand the reasoning behind not accessing the AVF arm for IVs and blood draws but what could the issue be in accessing the IJ on the same side for a tunneled line?

If the fistula is in the right arm or the left arm, then accessing the right internal jugular (IJ) vein for a tunneled catheter should be OK.  There is minimal risk for injury to the superior vena cava from a … Continue reading

Posted in Ask the Doctor, AV Fistula, Dialysis, Kidney-Related Health Questions

Hello Doctor, One of my uncle is recently detected with CKD. His creatinine level is 5.19 (reduced from 5.46 a week ago) and Phosphate is 5.50. He is a diabetic since last 15 years. Doctors are advising him to get the A V Fistula surgery done as he may get dialysis done at any time. But somehow he is not willing to do so and asking if he will control his Blood Sugar, Food and BP, is it possible to stay healthy and of course with monitoring of creatinine level. When do you think? When dialysis becomes a must or at which creatinine level, he must go for dialysis? Is there any medications for reducing creatinine level in blood?

There is no specific level of serum creatinine or level of kidney function that requires one to start dialysis. Dialysis is started to relieve symptoms that start to occur as a result of kidney failure.  Hence, the decision to start … Continue reading

Posted in Ask the Doctor, AV Fistula, Diabetes, Dialysis, Kidney-Related Health Questions, Nephrologist, Symptoms and Side Effects

My wife is on dialysis since March 2016. She has a fistula in her arm. Her arteries and veins are deep. So they have been having some problems using the fistula. We were talking to one of her doctors. He remembered a medical sales man talking to him about some sort of tube to connect to the fistula, with one end lying just under the skin. Then they would use that end and stick the tubing. He believes it was made of titanium. He is having someone trying to find the salesman. Have you heard of this? If so, do you know the name?

The only device that comes to mind is known as the Vital Access V-Wing device.  You can review the information about this device at:  http://www.vital-access.com/vwing/  

Posted in Ask the Doctor, AV Fistula, Kidney Failure, Kidney-Related Health Questions, Laboratory Testing, Treatments

I had to get my fistula on the side of my temporary catheter because when they did my fistula the first time on the other side, it stopped working after a week. Should I tell my doctor to place my temporary catheter on the other side now because I’m worried that it might cause problems for me since they are on the same side?

Having a fistula on the same side as your central venous catheter (hemodialysis catheter or CVC) should not pose a problem for your fistula.  I would not recommend changing the CVC unless there are problems of swelling in the arm … Continue reading

Posted in Ask the Doctor, AV Fistula, Blood/Urine Testing For Kidney Disease, Dialysis, Kidney Failure, Kidney-Related Health Questions, Laboratory Testing

How soon before dialysis is started does the fistula need to be put in?

I usually try to have a fistula in place at least 6 months before dialysis is anticipated.  It is often difficult to predict when dialysis may be needed, so I also recommend that when the estimated glomerular filtration rate (eGFR) … Continue reading

Posted in Ask the Doctor, AV Fistula, Dialysis, Treatments