Effects of Age and Diabetes on Blood Flow Rate and Primary Outcome of Newly Created Hemodialysis Arteriovenous Fistulas

Abstract

To study the feasibility of creating a radiocephalic hemodialysis fistula in elderly and diabetic patients, we prospectively studied 176 patients undergoing the first permanent vascular access creation and followed the outcome of fistula until primary failure or success was assessed. Color duplex ultrasonography was used to measure the blood flow rate. Fistula blood flow rate was significantly smaller in elderly patients, however, it was >400 ml/min in over 78% of the elderly patients with successful fistulas. There was no difference in fistula blood flow rate between nondiabetics and diabetics. Dialysis adequacy (Kt/V) via fistula was the same between age groups and between diabetes mellitus status. Old age or diabetes per se did not significantly predispose a new fistula to primary failure, but concurrent old age and diabetes markedly increase the risk. In conclusion, a good primary outcome of newly created radiocephalic fistula and adequate dialysis via fistula were demonstrated for elderly and diabetic patients. However, the longevity of fistula in elderly and diabetic patients needs further study.

Early Arteriovenous Fistula Failure

“…Various studies have documented that the increments in blood flow begin to occur soon after the construction of an AVF in a great majority of cases (6,(12)(13)(14)(15)(16)(17)(18)(19) (Figure 2A). A recent report demonstrated changes in blood flow in an AVF after its construction (6).…”

“…Although mechanisms of AVF maturation are complex and the exact timing of maturation is difficult to pinpoint, ample information exists in the literature regarding the general process (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Nevertheless, the phenomenon remains poorly understood by many nephrologists as well as vascular surgeons.…”

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“…Other factors included gender and diabetes mellitus. However, those factors were not related to the successful maintenance of revised vascular access [22][23][24].…”

“…Studies outside the Asian region revealed the overall superiority of upper arm AVF over lower arm AVF, a difference also true for diabetic patients [23]. In a Chinese study which included patients with radiocephalic AVF, age alone did not influence outcomes, but a combination of diabetes mellitus and old age were considered to be complicating factors [24]. Both the use of lower arm AVF and the combination of diabetes mellitus and age could affect fistula outcomes, but there is a lack of data to conclusively support this claim.…”

"Acesso venoso central para hemodiálise: avaliação prospectiva da ocorrência de complicações"

“…É a via permanente de maior durabilidade e segurança, realizada preferencialmente em regiões distais dos membros superiores a fim de permitir ao paciente maior liberdade de movimento durante a hemodiálise e nos afazeres cotidianos (LIMA, 2000). É necessário um período de quatro a oito semanas para que a FAV possa ser utilizada, considerando que neste período ocorre o espessamento da parede dos vasos e a dilatação do ramo venoso que permitirá a inserção repetida das agulhas de punções para a hemodiálise (LIN et al, 1998;IKEDA;BESARAB;RAJA, 2003).…”