Are backup arteriovenous fistulae necessary for patients on continuous ambulatory peritoneal dialysis?

The rationale for backup fistulae for patients on continuous ambulatory peritoneal dialysis (CAPD) is that many will require emergency haemodialysis and, subsequently, permanent haemodialysis. 42% of renal units in the UK have a policy of providing CAPD patients with backup arteriovenous fistulae. We have investigated whether this policy is justified. In our unit, of 176 patients who started CAPD between 1986 and 1989, most (73%) did not require haemodialysis over a median follow-up period of 4 years. Of the 153 backup fistulae created in 114 patients, only 10 were ever used for emergency haemodialysis. 23 other patients required 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 work. This finding indicates that most fistulae are not available for emergency haemodialysis when required. 94% of fistulae were never used for haemodialysis. Hence it is no longer justifiable to create backup fistulae in CAPD patients.