MANCHESTER, Jamaica—Hundreds of patients living with chronic kidney disease across southern Jamaica gained improved access to haemodialysis treatment through Mandeville Regional Hospital’s (MRH) arteriovenous (AV) fistula programme, which completed a milestone of 300 surgeries over the past five years.

Dr Varunesh Chand, consultant general surgeon at the MRH explained that the surgery, which involves creating a connection or anastomosis between an artery and a vein, typically in the forearm or arm, provides the vascular access required for dialysis treatment.

“AV fistulas are widely regarded as the preferred access option because they are more durable, carry a lower risk of infection, and generally result in fewer complications than dialysis catheters” he added.

He pointed out that many patients are now able to access the procedure closer to home; as prior to the establishment of the service at the MRH in 2012, patients in southern Jamaica had to travel to Kingston to undergo the procedure.

The service was introduced by Dr Akil Baker, now a consultant at the University Hospital of the West Indies, and has continued to grow under the leadership of Dr. Chand, since 2018.

As the main referral hospital serving southern Jamaica, MRH provides dialysis services to approximately 200 patients each year. To meet the growing demand, the hospital maintains a dedicated weekly operating schedule for AV fistula procedures.

With the adoption of surgeon based preoperative vein mapping and good administrative support the service has become efficient enough to even accommodate some referrals from the Spanish Town Hospital thereby helping to offload the case burden at hospitals in the corporate area.

Being the only regional hospital offering this service, the quality of care delivered through the programme has also been reflected in its outcomes.
A review conducted in 2024 revealed that nearly 80 per cent of fistulas matured successfully and were ready for use in haemodialysis, a success rate comparable to that achieved by specialised centres internationally.

“Timely referral for access creation is also essential to reduce morbidity faced by patients. In chronic kidney disease, ideally, we want to have a functional AV fistula even before the patient starts dialysis. Dr Kristen Little, Sister Marika Davis-Miller and the rest of the renal team at MRH have done an excellent job in getting patients evaluated as soon as possible” Dr Chand added.