Ward Consult – 76-year-old man for consideration of urgent Fistula formation 

Background

• Sarcoidosis
• Bronchiectasis – previous haemophilus influenzae pneumonia
• NIDDM
• Chronic Kidney Disease – Hypertensive and diabetic nephropathy
• Nephrectomy – Renal Cell Carcinoma
• Sarcoidosis

Issues

• Admitted to hospital with dyspnoea and worsening renal function
• CXR showed fluid overload and cardiomegaly. 
• Echocardiogram performed – pericardial effusion
• Pericardiocentesis – 1.2 Litres drained!
• Significant discussions between treating teams regarding the need for AV Fistula to commence Haemodialysis

Discussion

• Cardiology team advocating for a fistula. Concerned regarding uraemic cardiomyopathy as a cause of fluid overload and pericardial effusion
• Nephrology team of the opinion that uraemia is very unlikely to be the cause. 
• Additionally, renal function was improving and if dialysis was required then it could be done via VasCath initially
• Discussion regarding the use of a fistula in the immediate postoperative period. There is often a 6-week delay to allow for maturation of vessels.
• Timing of fistula use is dependent on the use of native vessels vs Graft. Can be used earlier with graft.

Plan

• Discussion between all teams ultimately concluded that procedure wasn’t required at present