Category Archives: AV Fistula

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

My husband is 47 years old and has IgA Nephropathy. He’s had two transplants and at this time, his kidney function is well. He was recently diagnosed with type 2 diabetes and started a new oral medication about two weeks ago. The fistula site is in his lower right forearm, over the last couple of days, the site has become “hard” and become very painful for him. He has taken over the counter pain relief and tried to lower the swelling with ice, as well as hoping to numb it to help with the pain. The pain usually stays localized at the fistula site but he has experienced pain in his whole arm. What can he do to help with the pain? Could this be serious? Thank you in advance for any help you can provide us.

The finding and symptoms that you describe about the fistula on his lower right arm do not sound proper or normal.  I suggest you consult his physician or the vascular surgeon that placed the fistula to have an examination.

Posted in Ask the Doctor, AV Fistula, Symptoms and Side Effects

I am 67, diabetic on insulin, hypertension (controlled), overweight (5’10”, 250 lbs) and diagnosed with Stage 5 CKD. Dialysis is imminent but efforts to hold it off are being investigated. I have been an avid Scuba and free diver and am concerned about continuing this activity should I go on dialysis. I dive using special protocols for diabetics and on scuba, use enhanced Oxygen air (30 -36 % O2). What precautions will be necessary for me to continue diving?

If you go on hemodialysis and have an arteriovenous fistula, you will have to use special care with the fistula to avoid infection and bleeding from the fistula during the dive.  You may need to wrap the fistula but you … Continue reading

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

What causes facular used for dialysis to leak fluids?

I have never heard of a “facular” and do not know what that is.  If you mean fistula, which is used for dialysis blood access, then leaking fluids into the fistula could mean anything from infection to blockage.  I recommend … Continue reading

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