Vascular access for haemodialysis for renal failure in a developing country

One thousand two hundred and thirty-five haemodialyses have been performed on 92 patients with renal failure. The mean number of dialyses per patient was 13.42 and the survival rate was 60.9%. One hundred and six arteriovenous shunts (98 of arm, 7 of ankle, and one of groin) were created. Three arteriovenous fistulae of arm were created in 2 patients with chronic renal failure. All the operations were performed under local or regional block anaesthesia. The mean shunt complications were clotting (27.4%), bleeding (17.9%) and infection (13.2%). The complications associated with the fistulae were non-function, heart failure, infection, aneurysmal dilatation and bleeding. One death from heart failure was attributable to arteriovenous fistula. It is recommended that patients with renal failure requiring haemodialysis in developing countries should have shunts or fistulae created under regional anaesthesia to avoid the problems of general anaesthesia in uraemic patients.