Early Failure of Arteriovenous Fistula (AVF): The Effect of Diabetes and Hypertension in a Cross-Sectional Study

Amir Bahrami-Ahmadi1, Morteza Khavanin Zadeh2, Haleh Chehrehgosha3

  • 1Occupational Medicine Research Center, Iran University of Medical Sciences, Tehran, Iran.

Insights

Hypertension may reduce the risk of early arteriovenous fistula (AVF) failure in hemodialysis patients, while diabetes history did not show a significant association. This finding could inform strategies to improve AVF outcomes for end-stage renal disease (ESRD) patients.

Area of Science:

  • Nephrology
  • Vascular Surgery
  • Clinical Epidemiology

Background:

  • Arteriovenous fistula (AVF) failure is a significant complication for patients undergoing hemodialysis, impacting long-term outcomes.
  • Identifying clinical predictors of AVF failure is crucial for improving patient management, but the specific roles of hypertension and diabetes remain unclear.

Purpose of the Study:

  • To investigate and compare the effects of hypertension and diabetes on the early failure of arteriovenous fistulas (AVFs) in patients with end-stage renal disease (ESRD).

Main Methods:

  • A retrospective study analyzed 400 ESRD patients undergoing their first AVF creation between July 2001 and August 2018.
  • Preoperative demographic data, medical history (diabetes, hypertension), and laboratory results were collected.
  • Statistical analysis, including chi-square and independent t-tests, assessed the relationship between comorbidities and early AVF failure (defined as failure within one month post-creation).

Main Results:

  • No statistically significant association was found between a history of diabetes and increased risk of early AVF failure (OR, 0.78; 95% CI, 0.25 to 2.43).
  • A history of hypertension was significantly associated with a lower risk of early AVF failure (OR, -2.82; 95% CI, -1.42 to -5.59), though this effect diminished in regression analysis (OR, -2.67; 95% CI, -0.97 to -7.36).
  • Patients in the non-early failure group had a higher Body Mass Index (p=0.041).

Conclusions:

  • A history of diabetes was not found to be a risk factor for early AVF failure in this cohort of ESRD patients.
  • Conversely, a history of hypertension appeared to be associated with a reduced risk of early AVF failure.
  • Further research is warranted to elucidate the mechanisms behind these observed associations and their clinical implications for AVF management.

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