Category Archives: AV Fistula

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:  

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

My wife – stage 5 early but serious. Artery to kidney is severely blocked. She is not candidate for transplant or even stent. Dialysis recommended. How does clean blood get through the blockage? If not stentable, how does the diverted blood get out to the machine and back into an artery? Does it bypass kidney all together? Will arterial walls take regular and continuous use even though sclerosed nearly everywhere?

Dialysis is performed using a fistula that is created usually in an upper extremity.  A fistula is a surgical connection between an artery and a vein that enlarges and becomes large enough to place two needles.  Dialysis can also be … Continue reading

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

My mother has a GFR of 17 she is suppose to decide on whether or not to start dialysis, she is 86 years old, she had a ultrasound of her arm to determine if her veins were good enough for fistula placement and the general surgeon said they were not too good and would do the surgery if she wanted in two steps. He also said she could wait until her kidney’s failure completely and get a picc line put in. He is concerned due to her being on coumadin for strokes and is worried about taking her off coumadin before surgery and the potential of having a stroke and what her quality of life would be. Do you think she would be better off waiting until her kidneys fail and get the picc line or taking the risk of the fistula placement even though it might not work?

These are very good questions and questions that you should ask of the nephrologist and vascular surgeon who are caring for your mother.  I am unable to give medical advice without performing a complete history and physical examination.  Decisions about … Continue reading

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

I am an RN employed in vascular access. We do not place PICC lines in dialysis patients with elevated BUN and creatinine levels at our facility. I was told at a recent vascular access conference that PICC line placement may be tied indirectly to reimbursement in the near future, as PICC lines can damage veins and affect fistula formation. Fistulas are more cost effective and better for the patient than grafts, so reimbursement may be less if grafts are placed. Do you have any information that would support this info? Many physicians are very unhappy with us when we do not place a PICC in these patients, and if this does happen it will greatly help us in our endeavor to protect the renal patient.

Yes, the Renal Networks have published recommendations based on the Fistula First project.  Please see: In addition, dialysis units who cannot place and maintain fistulas or who have an excessive number of tunneled hemodialysis catheters may be penalized by losing 0.5% … Continue reading

Posted in Ask the Doctor, AV Fistula, Dialysis

For a dialysis patient, graft or fistula are done to access into the blood vessel. Pure and impure blood does not mix. Can I know how a fistula works? ask

You can review information about an arteriovenous (AV) fistula on our web site at: A much more involved explantation and pictures are available at the National Institutes of Health web site at:

Posted in AV Fistula, Dialysis, Kidney-Related Health Questions

After having surgery on my fistula several times, it has failed yet again. There is no other place to put in my arms, so I am having surgery on Thursday, July 23, to do either a fistula or graft in my thigh. I had so much trouble with my fistula in my arm, which failed after 3 months. 1. How painful will this fistula be? I have been told it will be very painful. I have dialysis 3 times per week 4 hrs each time. 2. My arm was left with terrible scars, bumps, discolored skin. Is there anything I can do to minimize this damage short of plastic surgery?

I am afraid that the scars on the arms will persist and even plastic surgery will only contribute further to the scarring. The bruising will improve with time.  Thigh fistulas are no more painful than fistulas on the arms.  In … Continue reading

Posted in AV Fistula, Dialysis, Kidney-Related Health Questions

Can a patient receive kidney dialysis in their back? If not, where on the body can a patient receive dialysis only? Also, is it required for a patient to under go surgery for any kind of implant in order to have kidney dialysis? Have you ever seen where kidney dialysis is done through the back and with no types of implants?

It is rare that we have to put a dialysis catheter into the back.  This is generally done in patients who have exhausted all of there usual dialysis accesses in their arms and legs.  It is also done, whereby a … Continue reading

Posted in Ask the Doctor, AV Fistula, Dialysis