Endocrine Abstracts

Native arteriovenous fistula (AVF) represents the best vascular approach for chronic hemodialysis. It is difficult to create an AVF in diabetic hemodialysis patients due to atherosclerotic changes in the arteries. Although AVF becomes useless after a successful kidney transplant, there is no accepted policy for preserving or ligating AVF. The aim of this study was to compare the fate of AVFs in diabetic and non-diabetic patients after kidney transplantation.

Methods: The study included 129 (66 males, 63 females) consecutive kidney transplant recipients with AVF. Our cohort excluded patients with vascular access problems and/or permanent catheter placement prior to transplantation. The patients were divided into two groups: diabetics (n=25) and non-diabetics (n=104). Features and fates of AVF in both groups were evaluated.

Results: The female ratio, mean age and body mass index of diabetic patients were higher than those of non-diabetics (72% vs 43%, P<0.01; 51±8 vs 44±10 years, P=0.004 and 29.9±5.1 vs 26.9±7.8 kg/m², P=0.001, respectively). The renal replacement type, donor type, donor age, systolic and diastolic blood pressures, pulse beat and hemoglobin levels were comparable between two groups. The ratio of brachiocephalic AVF was higher in the diabetics (68% vs 43%, P=0.017). There was no significant difference between history of dialysis catheter (72% vs 86.5%) and the ratio of functioned AVF (36% vs 54.4%) in diabetic and non-diabetic groups, respectively. Symptoms and findings did not differ between two groups. The ratio of aneurysm in non-diabetic groups was higher (28.8% vs 8%, P=0.030). In both groups, cosmetic and esthetic concerns were not different. The ratio of steal syndrome was higher in diabetics (12% vs 2.9%, P=0.052). After transplantation, AVFs were closed in 6 diabetic patients and 31 non-diabetic patients (P>0.05). The causes of fistula closure were similar (infection in 7, pain in 4, edema in 9, cardiac in 13, own choice in 2 and aneurysm in 1 patient). The ratios of ejection fraction, left ventricular hypertrophy, pulmonary hypertension and valvular disease in the patients were similar in both groups. Mean serum creatinine levels in non-diabetics and diabetics were 1.33±0.59 and 1.48±0.65 mg/dl at the last visit, respectively (P=0.139).

Conclusion: Our study showed that the presence of diabetes mellitus did not significantly affect fistula-associated symptoms and findings, fistula fate and graft survival after kidney transplantation.