Back to 2024 Display Posters
The Impact Of Diabetes Mellitus On Arteriovenous Access Patency: A Retrospective Study From A Single Institution
Sasank Kalipatnapu, MBBS, MS, Umika Paul, BSE, Dejah R. Judelson, MD.
UMass Chan Medical School, Worcester, MA, USA.
OBJECTIVES: Patients with end-stage renal disease (ESRD) often rely on functional arteriovenous (AV) access for hemodialysis. Controversy surrounds the influence of diabetes on the long-term patency of AV access, with conflicting findings in prior research. This study investigates the relationship between diabetes and AV access patency, considering additional factors such as AV access type, preoperative blood glucose levels on the day of surgery, and postoperative glycemic control. METHODS: A retrospective analysis was conducted on patients who underwent AV hemodialysis access creation between January 1 and December 31, 2019 at a single institution. Patient data was collected, including diabetes status, access type, blood glucose levels on the day of surgery, postoperative glycemic control assessed by HbA1c levels within one-year after surgery, and number of interventions following AV access creation. The primary outcomes evaluated were primary patency (time to first intervention) and secondary patency (duration of viable access for dialysis). RESULTS: 192 patients were included. 113 (58.9%) had diabetes. The most common type of access created was a brachiocephalic fistula (100 patients (52%)). Kaplan-Meier survival analysis revealed that neither diabetes nor blood glucose levels on the day of creation significantly impacted primary patency (p = 0.99, 0.97, respectively) or secondary patency (p = 0.74,0.74 respectively). Competing risks analysis showed that age on day of surgery was significantly associated with mortality (p = <0.01). All types of fistulas had better odds of patency as compared to brachial-axillary graft. Diabetic status did not affect secondary patency (p = 0.53) or death (p = 0.62). Postoperative glycemic control, as measured by HbA1c levels within one year after AV access creation, did not exhibit a statistically significant association with secondary patency (p = 0.38) for patients with HbA1c > 6.5. Fistulagram with intervention was the most frequent type of procedure following AV access creation in both diabetics and non-diabetics, and the total number of interventions did not differ significantly between the groups (p = 0.53).CONCLUSIONS: Our findings show that diabetes status, blood glucose levels on the day of AV access creation, and postoperative glycemic control do not exert a discernible effect on the primary or secondary patency.
Back to 2024 Display Posters
