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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.
Abstract:
Background: Identification and control of clinical predictors of arteriovenous (AVF) failure can improve the long-term outcome of hemodialysis patients. The effects of these factors on the outcome of AVF are not still clear. So, we aimed this study to compare the effect of hypertension and diabetes on early failure of AVF. Methods: In this retrospective study, we evaluated 400 patients with ESRD referred to our clinic for the creation of the first AVF from July 14, 2001, through August 7, 2018. One month after AVF creation, the patients were referred to the clinic for patency control. Demographic characteristics, previous history of diabetes and hypertension, and laboratory data of all patients were recorded preoperatively. Data were entered to SPSS v.24 and Study data were analyzed with chi-square and independent student t-test. Then, early failure of AVF and its relationship with a history of diabetes and hypertension were assessed. Results: There was no statistically significant relationship between the history of diabetes and early AVF failure risk in ESRD patients (OR, 0.78; 95% CI, 0.25 to 2.43). Furthermore, the history of hypertension was significantly lower in the early failure of AVF group (OR, -2.82; 95% CI, -1.42 to -5.59). Although, this effect faded when using regression analysis (OR, -2.67; 95% CI, -0.97 to -7.36). There was a higher Body mass index in the non-early failure group (p = 0.041). There was no significant difference in age (p = 0.512), gender (p = 0.091), history of smoking (p = 0.605), treatment with insulin (p = 0.683), oral antidiabetic agents (p = 0.734), duration of diabetes (p = 0.384), and duration of hypertension (p = 0.093). Conclusion: We reported that the history of diabetes was not higher in the early failure group, while there was a lower risk of AVF failure in patients with a previous history of hypertension.
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