Watch That Waistline! Analysis Of Anthropometric Measures Affecting Outcomes In Primary Radiocephalic Fistulas In A Veteran Population.
Diana Otoya, MD, Kedar Lavingia, MD, Michael Amendola, MD.
VA Medical Center/VCU Health System, Richmond, VA, USA.
OBJECTIVES:The obesity paradox has been well described in the nephrology literature leading to improved outcomes in patients with elevated body mass index (BMI).Elevated BMI has been refuted as having a larger a causative failure rate in arteriovenous fistulas. We set forth to examine the outcomes of patients undergoing primary Radiocephalic fistula at the wrist or elbow (RCF) placement as it pertains to BMI as well as anthropometric measurements of the upper extremity and trunk. METHODS:We obtained Institutional Board Review approval to retrospectively query our Veterans Administration Hospital dialysis access database from August 2018 to August 2020 to identify all patients who had primary RCF placement. We followed outcomes until August 2021. Patients had demographics recorded, central line placement at time of RCF creation, BMI, upper extremity anthropometric measurements (diameter measures at the wrist, forearm, elbow and arm), vein mapping and waist diameters. Successful cannulation was defined as one or two needle cannulation and usage on dialysis. Vein mapping was undertaken to guide appropriate vein (cephalic vein and radial artery > 2.0 mm) as well as collect subclavian vein and brachial artery velocities. Fishers Exact Test* and unpaired t-test** were utilized. RESULTS:82 patients were evaluated for fistula placement during the time period of which 28% (n=23, all male) had primary RCF placements. These patients were then divided into those who had successful cannulation (Success, n=11) vs. those who did not (Failure, n=12). All patients were alive at the end of the study period. Mean anthropometric measures of upper extremity (as well as ratios), waist diameter, age, central line presence, brachial artery velocities and other demographics were not statistically significant between the two groups. CONCLUSIONS:Decreased BMI and elevated waist to BMI ratio were more common in patients succeeding in cannulation of their newly created RCF. Mean subclavian vein velocities in the failure group indicate a possible underlying mechanism of central stenosis. Further study utilizing these data collection points is warranted to add detail to the obesity paradox in patients having RCF placed for dialysis treatments.
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