PREDICTIVE PARAMETERS OF ARTERIOVENOUS FISTULA MATURATION FOR HEMODIALYSIS IN PATIENTS WITH DIABETES MELLITUS

Maturation fistula in diabetic patients

  • Radojica Stolić University of Kragujevac, Faculty of Medical Sciences, Department of Internal Medicine, Serbia
  • Marija Milic
  • Vekoslav Mitrovic
  • Bratislav Lazic
  • Suzana Milutinovic
  • Snezana Lazic
  • Kristina Bulatovic
  • Vladimir Mitrovic
  • Andrijana Karanovic
  • Sanja Jovanovic
DOI: https://doi.org/10.5937/afmnai42-51775
Keywords: Arteriovenous fistula, Hemodialysis, Diabetes mellitus, Maturation, Predictive parameters

Abstract


Background: Arteriovenous fistula (AVF) is recommended as the ideal vascular access for hemodialysis (HD), but, there are conflicting opinions when it comes to patients with diabetes mellitus (DM).

Objectives: To determine the predictive parameters of AVF maturation for HD in patients with DM.

Methodology: The investigation was organized as a retrospective, descriptive-analytical study. The target group of our research is 209 patients with DM, who were created an AVF for HD. We recorded demographic and gender characteristics, location and type of AVF at the time of creation, type of anastomosis, data on the initial (a)function of the fistula, HD catheter placement, and blood pressure. Before the operation, a Doppler ultrasound of the blood vessels was performed, and intraoperatively, the lumen of the artery and vein used to form the AVF was measured. We analyzed laboratory variables that are routinely controlled in our institution.

Results: Diabetics with successful maturing fistula significantly more often had proximally located AVF (p=0.004), end-to-side anastomosis type (p=0.036), and initial function (p=0.001). In univariate analysis, the brachiocephalic location of AVF (p=0.004), end-to-side type of anastomosis (p=0.039), and initial function of AVF (p=0.001) were predictive parameters of AVF maturation. Multivariable statistical analysis showed that brachiocephalic localization of AVF (p=0.021), end-to-side anastomosis type (p=0.004), and initial function of AVF (p=0.001) are predictive parameters of AVF maturation in diabetics.

Conclusions: Predictive parameters of fistula maturation, in patients with DM in our study, are the initial function of AVF, brachiocephalic location, and end to side anastomosis.

References

1. GBD 2021 Diabetes Collaborators. Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021. Lancet 2023; 15;402(10397):203-234. doi: 10.1016/S0140-6736(23)01301-6.
2. Shen Y, Cai R, Sun J, et al. Diabetes mellitus as a risk factor for incident chronic kidney disease and end-stage renal disease in women compared with men: a systematic review and meta-analysis. Endocrine 2017;55(1):66-76. doi: 10.1007/s12020-016-1014-6.
3. Lok CE, Huber TS, Lee T, et al. National Kidney Foundation. KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 2020; 75(4 Suppl 2): S1-S164. doi: 10.1053/j.ajkd.2019.12.001.
4. Yan Y, Ye D, Yang L, et al. A meta-analysis of the association between diabetic patients and AVF failure in dialysis. Ren Fail 2018;40(1):379-383. doi: 10.1080/0886022X.2018.1456464.
5. Gordon AC, Dholakia S, Ashby D, Crane JS. Diabetes should not dissuade arteriovenous fistula formation. Br J Diabetes 2016;16:119-122. http://dx.doi.org/10.15277/bjd.2016.077.
6. Stolic R. Most important chronic complications of arteriovenous fistulas for hemodialysis. Med Prince Pract 2013;22(3):220-8. doi: 10.1159/000343669.
7. Dember LM, Imrey PB, Beck GJ, et al. Hemodialysis Fistula Maturation Study Group. Objectives and design of the hemodialysis fistula maturation study. Am J Kidney Dis 2014;63(1):104-12. doi: 10.1053/j.ajkd.2013.06.024.
8. Bashar K, Zafar A, Elsheikh S, et al. Predictive parameters of arteriovenous fistula functional maturation in a population of patients with end-stage renal disease. PLoS One 2015 Mar 13;10(3):e0119958. doi: 10.1371/journal.pone.0119958.
9. Jeong S, Kwon H, Chang JW, et al. Comparison of outcomes between type 2 diabetic and non-diabetic incident hemodialysis patients with functioning arteriovenous fistulas. Medicine (Baltimore) 2019;98(48):e18216. doi: 10.1097/MD.0000000000018216.
10. Sabiu G, Gallieni M. Pathophysiology of Arteriovenous Fistula Maturation and Nonmaturation. Clin J Am Soc Nephrol 2023; 1;18(1):8-10. doi: 10.2215/CJN.13101122.
11. Ullah S, Imtiaz N, Ullah S, Arshad AR. Comparison of Primary Failure Rates for Radiocephalic, Brachiocephalic, and Brachiobasilic Fistulas Between Patients of Diabetes and Non-Diabetes with Chronic Kidney Disease. Pak Armed Forces Med J 2024;74(2): 415-419. DOI: https://doi.org/10.51253/pafmj.v74i2.8514.
12. Keser BN, Kaya F, Sandal V, et al. Hemoglobin A1c levels do not predict primary arteriovenous fistula failure in hemodialysis patients. Cardiovasc Surg Int 2021;8(3):139-144.
13. Yap YS, Chi WC, Lin CH, Liu YC, Wu YW. Association of early failure of arteriovenous fistula with mortality in hemodialysis patients. Sci Rep 2021; 11(1): 5699. https://doi.org/10.1038%2Fs41598-021-85267-6.
14. Conte MS, Nugent HM, Gaccione P, Roy-Chaudhury P, Lawson JH. Influence of diabetes and perivascular allogeneic endothelial cell implants on arteriovenous fistula remodeling. J Vasc Surg 2011;54:1383-1389. 10.1016/j.jvs.2011.05.005.
15. Salmela B, Hartman J, Peltonen S, Alback A, Lassila R. Thrombophilia and arteriovenous fistula survival in ESRD. Clin J Am Soc Nephro 2013;8:962–968. 10.2215/CJN.03860412.
16. Sedlacek M, Teodorescu V, Falk A, Vassalotti JA, Uribarri J. Hemodialysis access placement with preoperative noninvasive vascular mapping: comparison between patients with and without diabetes. Am J Kidney Dis 2001;38:560–564.
17. Lee T, Mokrzycki M, Moist L, Maya I, Vazquez M, Lok CE. North American Vascular Access Consortium. Standardized definitions for hemodialysis vascular access. Semin Dial 2011;24(5):515-24. doi: 10.1111/j.1525-139X.2011.00969.x.
18. Rooijens PP, Tordoir JH, Stijnen T, Burgmans JP, Smet de AA, Yo TI. Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg 2004;28(6):583-9. doi: 10.1016/j.ejvs.2004.08.014.
19. Dirk MH. Determinants of Arteriovenous Fistula Maturation. Clin J Am Soc Nephrol 2018; 13(9): 1307–1308.
20. Farrington CA, Robbin ML, Lee T, Barker-Finkel J, Allon M. Early predictors of arteriovenous fistula maturation: a novel perspective on an enduring problem. J Am Soc Nephrol 2020;31(7):1617-1627. doi: 10.1681/ASN.2019080848.
21. Janeckova J, Bachleda P, Utikal P. Evaluating the effectiveness of arterio venous fistula creation strategy in diabetics. Clin Surg 2018; 3:2132.
22. ElKassaby M, Elsayed N, Mosaad A, Soliman M. End-to-side versus side-to-side anastomosis with distal vein ligation for arteriovenous fistula creation. Vascular 2021;29(5):790-796. doi: 10.1177/1708538120976993.
23. Brzychczy A, Lejman W, Walatek B. Wpływ niektórych czynników jakościowych i ilościowych na funkcjonowanie przetoki tętniczo-żylnej przez okres dłuższy niż 24 miesiące. Nefrol Dial Pol 2006; 10: 12–16.
24. Konner K, Lomonte C, Basile C. Placing a primary arteriovenous fistula that works-more or less known aspects, new ideas. Nephrol Dial Transplant 2013; 28(4): 781-784, doi: 10.1093/ndt/gfs463.
Published
2025/11/19
Issue
Vol. 42 No. 1 (2025): Acta facultatis medicae Naissensis
Section
Originalni rad / Original article