Pain resulting from arteriovenous fistulae: prevalence and impact

Aitken, E., McLellan, A., Glen, J., Serpell, M. , Mactier, R. and Clancy, M., (2013) Pain resulting from arteriovenous fistulae: prevalence and impact. Clinical Nephrology, 80(11), pp. 328-333. (doi: 10.5414/CN107917)

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Introduction: The burden of pain from cannulation of arteriovenous fistulae (AVF) and the impact it has on quality of life is poorly described in the literature. Methodology: A pain score questionnaire was employed for all patients in the West of Scotland dialyzing via AVF (n = 461). Pain was assessed using visual analogue score (VAS) and McGill pain score. Patients with severe pain (VAS > 5) were compared to those with minimal pain. Results: The questionnaire as completed by 97.5% of the patients. Median VAS on cannulation was 3 (IQR 0.5 – 4.5). Of those who had completed the questionnaire, 24.4% had severe pain on cannulation and 3.2% experienced severe chronic pain. 53 patients (11.3%) cut a dialysis session short due to pain. Of the patients with severe chronic pain, 46.7% had a physical complication affecting their AVF (e.g., venous stenosis, pseudoaneurysm). Following treatment of the problem, pain improved in 71.4% and resolved completely in 14.3%. Brachiobasilic AVF was associated with a higher incidence of severe pain than either brachiocephalic or radiocephalic AVF (50%, 23.3% and 24.4% respectively; p = 0.03). There was a trend towards more severe pain with rope-ladder cannulation (27.7%) compared to button-hole cannulation (18.2%); however, this difference did not reach statistical significance (p = 0.09). Conclusions: Pain from AVF is poorly recognized and an under-reported problem. While severe pain resulting in the avoidance of dialysis is rare, it can lead to significant difficulties and ultimate abandonment of AVF. Pain is often suggestive of an underlying anatomical problem.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Clancy, Mr Marc and Serpell, Dr Michael
Authors: Aitken, E., McLellan, A., Glen, J., Serpell, M., Mactier, R., and Clancy, M.,
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Clinical Nephrology

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