Mandeville Regional Hospital completes 300 AV fistula surgeries in five-year kidney care expansion

People living with chronic kidney disease across southern Jamaica are finding it easier to reach haemodialysis care, thanks to steady growth in Mandeville Regional Hospital's (MRH) arteriovenous (AV) fistula programme. The hospital has now carried out 300 of these procedures over the past five years.

Dr Varunesh Chand, consultant general surgeon at MRH, said the operation forms a surgical link between an artery and a vein, usually in the forearm or arm, to create the vascular access dialysis depends on.

"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 explained.

Chand noted that many patients can now have the procedure done near home. Before MRH introduced the service in 2012, residents of southern Jamaica typically had to travel to Kingston for access surgery.

The programme was started by Dr Akil Baker, who now works as a consultant at the University Hospital of the West Indies. It has continued to expand under Chand's leadership since 2018.

As the main referral hospital for southern Jamaica, MRH provides dialysis services to roughly 200 patients each year. To meet rising demand, the facility keeps a dedicated weekly operating schedule for AV fistula cases.

With surgeon-led preoperative vein mapping and solid administrative support, the service has become efficient enough to accept some referrals from Spanish Town Hospital, helping to reduce the workload at hospitals in Kingston.

MRH is the only regional hospital offering this specialised service. The quality of care is reflected in clinical outcomes. A review carried out in 2024 found that nearly 80 per cent of fistulas matured successfully and were ready for haemodialysis use, a success rate on par with 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," said Dr Chand.

"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."

The milestone highlights MRH's ongoing push to broaden specialised services and ensure patients with chronic kidney disease can receive high-quality care closer to home.