Below what platelet count would you avoid using an AV fistula in a patient with ESKD and thrombocytopenia?

Great question & the answer is likely debatable based on personal experience.

Review of some case reports show no evidence of prolonged bleeding after AVF cannulation with platelet counts as low as 37,000 (1). Platelet counts can drop by 5- 15% with initiation of HD normally. They fall during the first hour of dialysis and then return to baseline by the end of the treatment (2).

Spontaneous bleeding tends to occur with PLT counts < 20,000 (3). So, it may be prudent to keep PLT counts >25,000- 30,000. Some have suggested avoiding AVF cannulation when PLT < 50,000 (3). In general, thrombocytopenia due to platelet consumption is less likely to cause bleeding at any given platelet count compared with those with thrombocytopenia due to decreased ...