Q: I am a 34 years old chronic renal failure patient for the past 3 years. An AV fistula was made a year and a half back. Since the serum creatinine value is stable at around 6 for the past 2 years, my doctor is advising to get closure of the AV fistula. At present, the vein has swollen a lot up to the elbow level. I am on conservative medical management. What does it mean exactly by closure of AV fistula?

A:You have a kidney function of (GFR 14 ml/min) which means a kidney function of 14 % (stage V of chronic kidney disease). In stage V, you require renal replacement therapy in the form of dialysis or kidney transplantation. You are already close to requiring dialysis so there should be no question of closing the AV fistula. If there is an aneurysm in the fistula that may have to be repaired. You should not close the fistula as you will require dialysis soon.