Impact of a Structured Group Education Model to Promote Self-surveillance and Early Detection of Fistula Dysfunction in Dialysis Patients

Objective: Progressive arteriovenous fistula (AVF) stenosis often remains undetected until thrombosis or access loss occurs, particularly when repeated difficult cannulations are misinterpreted as technical error rather than underlying vascular compromise. To address this diagnostic gap, we developed the AVF Care Workshop, an educational initiative that trains dialysis patients, caregivers, and homedialysis technicians to detect critical AVF stenosis using stethoscope-based auscultation. This model is not intended as a diagnostic replacement but serves as a technical adjunct to support timely referral to vascular access teams. Materials and Methods: Between November 2023 and June 2025, structured workshops were conducted across multiple centers. Each session enrolled 15–30 dialysis patients encouraged to attend with a caregiver and their home technician to form a triad for reinforced learning. Training included: Basic use and placement of the stethoscope at the first puncture point to detect a normal continuous bruit (explained to patients as the “continuous sound”), Use of proximal and distal compression to mimic AVF stenosis and produce a systolic-only bruit (“interrupted sound”), Recognition that the absence of bruit strongly suggests AVF or graft thrombosis, warranting urgent clinical escalation. Each participant received a “Kidney Warrior Toolkit” containing a stethoscope, compression cap, QR-coded educational videos, renal diet guides, wristband, and a self-check visual magnet. Bi-weekly telephonic follow-ups assessed compliance and outcomes. Results: Among 245 trained patients, 179 (73%) regularly performed auscultation. Thirty-six identified altered bruit patterns; 29 had confirmed AVF stenosis; and 2 had graft thrombosis. All findings were validated through Doppler and/or angiography. Thirty of 31 underwent successful salvage (96.7% salvage rate). Prior AVF intervention correlated with higher compliance and detection accuracy. Conclusions: The AVF Care Workshop is a reproducible, scalable, and a low-resource model that enables the early recognition of critical AVF stenosis. It complements formal surveillance and enhances timely salvage, improving long-term access outcomes.