Obesity is an independent risk factor for primary patency loss in 12 months: A 3-year retrospective study of vascular...

Obesity is common among patients with end-stage renal disease; however, its impact on vascular access (VA) outcomes remains uncertain. We aimed to evaluate the association between body mass index (BMI) and VA patency.

We retrospectively analyzed 396 patients who underwent arteriovenous fistula (AVF) or arteriovenous graft (AVG) creation (2021-2024), stratifying them by BMI (cutoff of 30 kg/m²). Primary outcomes included primary patency and assisted primary patency, secondary patency, and patient survival.

We analyzed 396 patients (mean age 66.0 ± 14.2 years; 62.1% male). Comorbidities were frequent: hypertension 94.2%, diabetes 54.8%, coronary artery disease 35.6%, peripheral arterial disease 21.7%, cerebrovascular disease 23.0%, and cancer 25.0%. Prior kidney transplantation and renal replacement therapy were present in 12.6% and 69.9% of patients, respectively. Left-sided access and autologous access was predominated (89.9% and 68.2% each), while secondary vascular access at presentation was uncommon (6.6%). The average follow up period was 8.36 ± 9.27 months. Patients with obesity (BMI ⩾30) had significantly lower primary patency than those without obesity (25.0% vs 48.0%, p = 0.024), with comparable assisted patency and long-term outcomes. BMI ⩾30 was an independent predictor of primary patency loss (hazard ratio (HR) 1.707, p = 0.038). AVG formation was a risk factor for assisted patency failure (HR 8.983, p < 0.001).

Obesity was associated with early access failure; not with long-term outcomes. Durable VA outcomes can be achieved in patients with obesity through surveillance and timely interventions.