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[Vascular access for chronic hemodialysis in diabetic patients]
D Spotti1, G Slaviero, G Ferrari
1Istituto Scientifico H San Raffaele, Università degli Studi di Milano.
Insights
This study found that distal arteriovenous fistulae are a viable vascular access for hemodialysis in patients with diabetes and kidney failure. These fistulae showed good long-term survival rates with thrombosis as the main complication.
Area of Science:
- Nephrology
- Vascular Surgery
- Diabetology
Background:
- Chronic kidney disease (CKD) patients often require hemodialysis.
- Vascular access is crucial for effective hemodialysis.
- Diabetic patients with uremia present unique challenges for vascular access.
Purpose of the Study:
- To evaluate vascular access complications in uremic diabetic patients undergoing chronic hemodialysis.
- To determine the short- and long-term incidences of these complications.
- To assess the efficacy of distal arteriovenous fistulae in this patient population.
Main Methods:
- Study included 33 uremic diabetic patients on chronic hemodialysis.
- 46 vascular anastomoses were created: 39 Brescia-Cimino arteriovenous fistulae and 7 PTFE grafts.
- Actuarial survival rates were calculated at one, two, and four years.
Main Results:
- The actuarial survival rates for vascular access were 88% (1 year), 79% (2 years), and 63% (4 years).
- Thrombosis was the most frequent complication observed.
- Distal arteriovenous fistulae demonstrated acceptable patency rates.
Conclusions:
- Distal arteriovenous fistulae are a suitable vascular access option for hemodialysis in diabetic patients with uremia.
- Careful monitoring is necessary to manage complications like thrombosis.
- This approach supports long-term hemodialytic treatment in this challenging cohort.
Abstract:
The aim of this study carried out on 33 uremic diabetic patients submitted to chronic hemodialytic treatment was to assess the kind of complications related to the vascular approach used as well as their short- and long-term incidences. Out of the 46 anastomoses prepared, 39 were arteriovenous fistulae according to Brescia-Cimino and 7 were PTFE grafts. The actuarial survival rate was 88%, 79%, and 63% after one, two and four years, respectively. The most frequent compliance was thrombosis. Our experience demonstrates that the distal arteriovenous fistula may be considered a valid vascular access for hemodialysis also in diabetic patients.