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Overweight patients receiving radiocephalic arteriovenous fistulas do not have improved functional outcomes despite earlier referral and younger age
Michael F. Amendola, MD, Marcela Woogen-Fisher, MD, John Pfeifer, MD, Mark Levy, MD, Ronald Davis, MD.
VA Medical Center/VCU Health System, Richmond, VA, USA.
OBJECTIVES:
Radiocephalic arteriovenous fistula (RC) has become the preferred first line access procedure for hemodialysis patients. Overweight patients as measured with a Body Mass Index (BMI) greater than 25 kg/m2 are thought to have worst outcomes compared to patients with lower BMI. Some investigators have refuted this notion. We examined the outcomes of our normal and overweight patients with RC placement
METHODS:
We obtained institutional board review approval to retrospectively query our VA Medical Center database from January 1, 2003 to December 31, 2008 to identify all patients who had RC fistula placement. RC outcomes were followed for an additional 48 months. Low BMI ( 25 kg/m2) patients were examined.
RESULTS:
A total of 284 male patients had 571 access procedures performed during the study period. Of these 109 (19.1%) were RC. 40.4% (n=44) were in a low BMI group and 59.6% (n=65) were in the high BMI group. Kaplan-Meier analysis indicated similar functional patencies of RC fistulas in the low and high BMI groups (p=0.749).
Outcomes of Low vs High BMI | Low BMI (n=44) | High BMI (n=65) | p value | Average BMI kg/m2
(mean +/- SD) | 22.11 +/- 1.78 | 31.13 +/- 4.70 | <0.0001† | | Alive at the end of the study | 21 pts (47.8%) | 29 pts (44.6%) | 0.8452* | Age at the time of surgery
(mean years +/- SD) | 73.45 +/- 10.58 | 68.86 +/- 11.14 | 0.0280† | | On Dialysis at the Time of Surgery | 20 pts (45.4%) | 11 pts (16.9%) | 0.0021* | Successful
Cannulation | 16 pts (36.4.%) | 27 pts (41.5%) | 0.6904* | Endovascular Interventions per Access
(mean +/- SD) | 0.5625 +/- 0.8139 | 0.4444 +/- 0.7511 | 0.5583† | *Fisher’s Exact Test † Wilcoxon Rank Sum CONCLUSIONS:RC is considered a first line operative procedure for those receiving hemodialysis. Patients had similar functional outcomes and endovascular procedures regardless of BMI. Interestingly, patients with higher BMI were statistically younger and had earlier referral for RC placement. Despite these two perceived advantages, functional outcomes did not differ between the two groups
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