Endocrine Abstracts

Vascular access remains both a life line and a ‘weak link for patients receiving hemodialysis (HD) therapy. It difficult to create an arteriovenous fistula (AVF) in diabetic hemodialysis patients due to atherosclerotic changes in arteries. This study investigated the fate of AVFs in diabetic and non-diabetic HD patients.

Methods: The study included 306 patients (142 females, 164 males) on regular HD treatment with AVF. We excluded patients dialyzed with permanent catheter placement or arteriovenous graft. The patients were divided into two groups: diabetics (n=131, 66 females) and non-diabetics (n=175, 76 females). The history of cardiovascular diseases and AVF survival were evaluated.

Results: The dialysis features of both groups were comparable. The mean age and body mass index of diabetic patients were higher than those of non-diabetics (64±10 vs 60±15 years, P<0.014, and 27.8±5.3 vs 24.2±4.1 kg/m², P<0.001, respectively). There was no significant difference between the ratios of smoking and dyslipidemia in diabetic and non-diabetic groups (16.8% vs 21.7% and 7.6% vs 5.1%, respectively, P>0.05). The ratios of coronary artery, peripheral and cerebral artery diseases were higher in diabetic patients than non-diabetics (6.2% vs 18.3%, P=0.002; 2.3% vs 7.6%, P=0.049; 2.1% vs 7%, P=0.004, respectively). The longevity of AVFs was 26 months (range 0-1349) in diabetics and 30 months (range 0–-294) in non-diabetics (P=0.334). The ratios of nonfunctioned AVF in diabetic group did not differ from non-diabetic group (26.7% vs 20.6%, P=0.220).

Conclusion: Inadequate arterial inflow in diabetic HD patients have been increasingly recognized as the major cause of fistular malfunction. However, our study showed that the presence of diabetes mellitus in HD patients did not adversely affect longevity of AVF despite increased prevalence of arterial disease.