When to get an Av fistula

[amycdaa]

I am in high stage five. When should I get  a fistula placed. It will be placed in my leg. When did you get yours?

[Michael Murphy]

I got mine 2 years before starting Dialysis.  Your nephrologist should recommend a Vascular surgeon.  The more time it has to mature. The easier it is to start dialysis.

[iolaire]

My recommendation is as soon as possible to give it time to get nice and mature prior to use.  I had it 2-3 years in advance and needed to get one set of angioplasty to get a narrowing spot opened up prior to dialysis.

I have a left forearm fistula that is getting huge after use for three plus years.  It is visible when I wear short sleeve shirts so I'm a bit sensitive about wearing say a polo at work, but on the weekends I expose it all the time. 

If I had a choice I probably would pass on a leg fistula (for another area) because they look a bit awkward having tech's working with a needle down by the groin, plus you have to wear shorts of some sort to give them access.  I personally don't like the feeling of the plastic chairs on my skin so I always wear pants and a long shirt to dialysis - even in the tropics - and thus would not by choice want to have shorts on each session.  (Also do those leg fistulas chafe as they grow large?)  I see a few male patients in my clinic with leg fistulas (up by the groin) and one woman.  The Males wear normal sports like shorts they can pull up, the woman wears something like boy shorts (I think that's the name), black shorts that could be longer length undies (not that revealing), and a dress she can pull down after treatment.  So they are sitting around in shorts the whole treatment.

[LorinnPKD]

But on the plus side, they have their hands free!  Sometimes I get so envious to watch them knitting or playing a game on their phones! 

[iolaire]

But on the plus side, they have their hands free!  Sometimes I get so envious to watch them knitting or playing a game on their phones!

Yes I probably would be forced to work if I had full use of my hands...

[Charlie B53]

I've been sooooooo spoiled using my perma-cath.  When it comes time my fistula matures and the clinic wants to use it, and tells me to keep my arm still.

We may have a problem.

[Sue]

I had my fistula placed in April 2012. It is beautifully matured and as yet unused !! My kidney function was 12%, I was advised to have fistula op when it dropped below 15%,

[Simon Dog]

Yes I probably would be forced to work if I had full use of my hands...

Not in the US.   Dialysis is a "stated condition" qualifier for SSDI; no need to prove inability to work.

[iolaire]

Yes I probably would be forced to work if I had full use of my hands...

Not in the US.   Dialysis is a "stated condition" qualifier for SSDI; no need to prove inability to work.

I mean I'd feel obligated to work for my current full time employer if I had use of my hands. I'm salaried full time, but really am working less than 40 hours because of dialysis, except for when projects are due and I work extra on the weekends and evenings. 

SSDI is no replacement for a decent job's income.

[Simon Dog]

SSDI is no replacement for a decent job's income.

You got that right.   Works out to the equivalent of a  $16/hour full time job for me, with no benefits.

[Hazmat35]

Get your AV Fistula NOW...the sooner the better...hoping that you never, ever have to use it.  The sooner you get it and let it mature and build up; the better you are, if you have to use it. 

I had mine put in, about 6 months before I started Dialysis, and it was fully matured by then, and has worked GREAT ever since.  I go to get Fistulagrams done on it, about every 3 to 4 months to get it running smooth; just like a cars engine or a house, you have to maintain it for it to work properly.

God willing, you will never have to!  Good luck. 

[MrNaturalAZ]

Even if I expect to do PD? I visited the nephrologist today and saw a different doctor than I usually do. He started talking about my getting a fistula, and I said my regular neph had recommended PD and I wanted to try that. He said I still ought to get a fistula just to be prepared in case it turns out that I can't do PD for some reason or it doesn't work.

So... reading this thread, it seems that's good advice? Better to have one and not use it than need one and not have it?

[iolaire]

Even if I expect to do PD? I visited the nephrologist today and saw a different doctor than I usually do. He started talking about my getting a fistula, and I said my regular neph had recommended PD and I wanted to try that. He said I still ought to get a fistula just to be prepared in case it turns out that I can't do PD for some reason or it doesn't work.

So... reading this thread, it seems that's good advice? Better to have one and not use it than need one and not have it?

The fistula is a great backup, most people I read about who did PD managed it for a few years then end up on HD because of a major infection.  If you jump to HD with a fistula it will be developed well and you will not need to get the catheter installed.  Some people do well with catheters, but with the fistula you can still get it wet and such with little risk of infection.

FYI: I'm planning on try to get the aneurisms minimized in my fistula and keep it active for many years well I live with my donor kidney.  Having this same good strong fistula in case of emergency seems smart to me.  Hopefully that will be a long time from now.

[Cupcake]

I started PD about a year ago after a slow decline in renal function over years. No one ever recommended I get a fistula, maybe because I've been focused on transplant since day one.

[jambo101]

Got my fistula grafted a couple of weeks ago in preparation for dialysis. Kidney function has been diagnosed at 13% not sure when the nephrologist is going to say its time to start the dialysis treatment.

[Michael Murphy]

Personally I did not start Dialysys when my nephrologist wanted me to.  I spen 2 additional years delaying the start of dialysis.  My feeling is that lab work is a good indicator of future dialysis but not when to start.  How you feel is a better indication of when to start.  Just don’t push past the I don’t feel good stage and get really sick.