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Updated: Jan 4, 2026
Creating Radio-cephalic Arteriovenous Fistula in the Forearm with a Modified No-Touch Technique
Published on: April 1, 2022
Prediction model for successful radiocephalic arteriovenous fistula creation in patients with diabetic nephropathy
J Suresh Kumar1, K S Sajeev Kumar2, E T Arun Thomas2
1Department of Cardiothoracic and Vascular Surgery, Government Medical College, Thiruvananthapuram, Kerala, India.
Insights
Diabetic nephropathy patients undergoing radiocephalic arteriovenous fistula (AVF) creation face high primary failure risks. Key predictors include palpable radial artery, smaller diameter, low peak systolic velocity, and calcification, aiding in patient selection for hemodialysis access.
Area of Science:
- Nephrology
- Vascular Surgery
- Radiology
Background:
- Arteriovenous fistula (AVF) is the preferred hemodialysis access for chronic kidney disease (CKD) patients.
- Diabetic nephropathy increases AVF primary failure risk due to vascular complications like atherosclerosis and calcification.
Purpose of the Study:
- To identify risk factors for radiocephalic AVF primary failure in end-stage renal disease (ESRD) patients with diabetic nephropathy.
- To develop a predictive model for AVF primary failure in this patient group.
Main Methods:
- Retrospective analysis of 66 ESRD patients with diabetic nephropathy undergoing wrist radiocephalic AVF creation.
- Univariate and multivariate logistic regression to identify risk factors.
- Development of a risk prediction model based on vessel palpation, diameter, flow velocity, and calcification.
Main Results:
- Thirty-one of 66 patients experienced primary AVF failure.
- Independent risk factors identified: palpable radial artery (OR=15.3), smaller radial artery diameter (OR=16.5), radial artery peak systolic velocity <45 cm/s (OR=8.5), and linear radial artery calcification (OR=7.9).
- The predictive model achieved an AUC of 0.886, with a cutoff score of 1.5 showing 83.9% sensitivity and 80.0% specificity.
Conclusions:
- Palpation of the radial artery, its diameter, peak systolic velocity, and calcification are significant predictors of radiocephalic AVF primary failure in diabetic nephropathy patients.
- The developed risk prediction model can assist in selecting suitable candidates for AVF creation, potentially improving outcomes.
Abstract:
Arteriovenous fistula (AVF) is the most appropriate vascular access for all chronic kidney disease patients for hemodialysis. However, patients with diabetic nephropathy are at increased risk for primary failure after AVF creation, mainly due to atherosclerosis and calcification of blood vessels. We conducted this study to find out the risk factors for primary failure of radiocephalic AVF in end-stage renal disease (ESRD) patients due to diabetic nephropathy and develop a risk predicting model. This study was conducted at a tertiary care teaching hospital of South India. Patients with ESRD due to diabetic nephropathy whom underwent left radiocephalic AVF at wrist were enrolled. Risk factors for primary failure were analyzed by univariate and multivariate logistic regression models. Sixty-six patients were included in the study. Thirty-one patients had a primary failure. Independent risk factors for primary failure were palpable vessel wall of the radial artery (P = 0.003, odds ratio [OR] = 15.317), smaller radial artery diameter (P = 0.001, OR = 16.526), radial artery peak systolic velocity (PSV) <45 cm/s (P = 0.005, OR = 8.494), and linear radial artery calcification (P = 0.006, OR = 7.942). The risk predicting model obtained by adding the score given for each risk factors (vessel wall not palpable = 0, palpable = 1, no linear calcification in digital X-ray = 0, linear calcification = 1, PSV ≥45 cm/s = 0, <45 cm/s = 1 and 2.5 - radial artery diameter in mm) had an area under receiver-operating characteristic curve of 0.886. Cutoff score of 1.5 had sensitivity of 83.9% and specificity of 80.0% for primary failure. Risk predicting model for primary failure based on condition of the vessel wall on palpation, radial artery diameter, flow velocity, and calcification may be helpful for suitable patient selection.
