ARE BACKUP ARTERIOVENOUS-FISTULAS NECESSARY FOR PATIENTS ON CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

The rationale for backup fistulae for patients on continuous ambulator y peritoneal dialysis (CAPD) is that many will require emergency haemo dialysis and, subsequently, permanent haemodialysis. 42% of renal unit s in the UK have a policy of providing CAPD patients with backup arter iovenous fistulae. We have investigated whether this policy is justifi ed. In our unit, of 176 patients who started CAPD between 1986 and 198 9, most (73%) did not require haemodialysis over a median follow-up pe riod of 4 years. Of the 153 backup fistulae created in 114 patients, o nly 10 were ever used for emergency haemodialysis. 23 other patients r equired emergency haemodialysis, but when required their fistulae were no longer functioning. The mean fistula patency times among patients in this study compared very favourably with those in other published w ork. This finding indicates that most fistulae are not available for e mergency haemodialysis when required. 94% of fistulae were never used for haemodialysis. Hence it is no longer justifiable to create backup fistulae in CAPD patients.