Diabetes should not dissuade arteriovenous fistula formation

Andrew C Gordon, Sham Dholakia, Damien Ashby, Jeremy s Crane


Background: Fistula maturation is a complex multifactorial process with the effect of diabetes on vessel augmentation during fistula formation remaining unclear. Variation in results has reflected in a range of clinical practice with regard to patient selection and fistula formation and so requires more study. The aim of our study was to compare outcomes of diabetic and non-diabetic patients undergoing formation of a new upper limb arteriovenous fistula (AVF) to assess whether diabetes has a prognostic effect on outcome.

Methods: A retrospective cohort study analysing 339 patients looking at both radiocephalic and brachiocephalic fistula formation in diabetic and non-diabetic patients was designed, with the primary outcome being fistula failure and then time taken to mature.

Results: No difference was found between diabetic and non-diabetic patients in terms of fistula failure or time to mature.

Conclusions: With AVF remaining the best access for dialysis, diabetic patients should not be discouraged from being offered AVF formation as they have equivalent outcomes to non-diabetic patients.


diabetes, arteriovenous, fistula formation, dialysis

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Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4-14. http://dx.doi.org/10.1016/j.diabres.2009.10.007

Diabetes UK. State of the Nation 2014. Available at: https://www.diabetes.org.uk/About_us/What-we-say/Statistics/State-of-the-nation-challenges-for-2015-and-beyond

NKF-DOQI clinical practice guidelines for vascular access. VIII. Timing of access placement. Am J Kidney Dis 1997;30(Suppl 3):S160.

Fluck R, Kumwenda M. UK Renal Association Clinical Practice Guidelines 5th Edition 2008-2011, page 3, Vascular access for haemodialysis.

Dixon BS. Why don’t fistulas mature? Kidney Int 2006;70:1413-22. http://dx.doi.org/10.1038/sj.ki.5001747

Asif A, Roy-Chaudhary P, Beathard G. Early arteriovenous fistula failure: a logical proposal for when and how to intervene. Clin J Am Soc Nephrol 2006;1:332-9. http://dx.doi.org/10.2215/CJN.00850805

Roy-Chaudhury P, Spergel LM, Besarab A, Asif A, Ravan P. Biology of arteriovenous fistula failure. J Nephrol 2007;20:150-63.

Malovrh M. Native arteriovenous fistula: preoperative evaluation. Am J Kidney Dis 2002;39:1218-25. http://dx.doi.org/10.1053/ajkd.2002.33394

Sidawy AN, Spergel LM, Besarab A, et al. The Society for Vascular Surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous haemodialysis access. J Vasc Surg 2008;48(5 Suppl):S20-5. http://dx.doi.org/10.1016/j.jvs.2008.08.042

Sedlacek M, Teodoresku V, Falk A, Vassalotti JA, Uribarri J. Hemodialysis access placement with preoperative vascular mapping: comparison between patients with and without diabetes. Am J Kidney Dis 2001; 38:560-4. http://dx.doi.org/10.1053/ajkd.2001.26873

Murphy GJ, Nicholson ML. Autogeneous elbow fistulas: the effect of diabetes mellitus on maturation, patency, and complication rates. Eur J Vasc Endovasc Surg 2002;23:452-7. http://dx.doi.org/10.1053/ejvs.2002.1613

Lin SL, Huang CH, Chen HS, Hsu WA, Yen CJ, Yen TS. Effects of age and diabetes on blood flow rate and primary outcome of newly created hemodialysis arteriovenous fistulas. Am J Nephrol 1998;18:96-100. http://dx.doi.org/10.1159/000013315

Allon M, Ornt DB, Schwab SJ, et al. Factors associated with the prevalence of AV fistulas in hemodialysis patients in the HEMO study. Kidney Int 2000;58:2178-85. http://dx.doi.org/10.1111/j.1523-1755.2000.00391.x

National Kidney Foundation. I. Clinical Practice Guidelines and Clinical Practice Recommendations 2006 Updates; I. Clinical Practice Guidelines for Vascular Access. Available at: https://www.kidney.org/sites/default/files/docs/12-50-0210_jag_dcp_guidelines-hd_oct06_sectiona_ ofc.pdf

Afsar B, Elsurer R. The primary arteriovenous fistula failure – a comparison between diabetic and non-diabetic patients: glycemic control matters. Int Urol Nephrol 2012;44:575-81. http://dx.doi.org/10.1007/s11255-011-9978-x

Fokou M, Teyang A, Ashuntantang G, et al. Complications of arteriovenous fistula for hemodialysis: an 8-year study. Ann Vasc Surg 2012;26:680-4. http://dx.doi.org/10.1016/j.avsg.2011.09.014

Lauvao LS, Ihnat DM, Goshima KR, Chavez L, Gruessner AC, Mills JL Sr. Vein diameter is the major predictor of fistula maturation. J Vasc Surg 2009;49:1499-504. http://dx.doi.org/10.1016/j.jvs.2009.02.018

Saran R, Elder SJ, Goodkin DA, et al. Enhanced training in vascular access creation predicts arteriovenous fistula placement and patency in hemodialysis patients: results from the dialysis outcomes and practice patterns study. Ann Surg 2008;247:885-91. http://dx.doi.org/10.1097/SLA.0b013e31816c4044

Goodkin DA, Pisoni RL, Locatelli F, Port FK, Saran R. Hemodialysis vascular access training and practices are key to improved access outcomes. Am J Kidney Dis 2010;56:1032-42. http://dx.doi.org/10.1053/j.ajkd.2010.08.010

Konner K. Primary vascular access in diabetic patients: an audit. Nephrol Dial Transplant 2000;15:1317-25. http://dx.doi.org/10.1093/ndt/15.9.1317

Ernandez T, Saudan P, Berney T, Merminod T, Bednarkiewicz M, Martin PY. Risk factors for early failure of native arteriovenous fistulas. Nephron Clin Pract 2005;101:39-44. http://dx.doi.org/10.1159/000085710

DOI: https://doi.org/10.15277/bjd.2016.077


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