Vascular access in diabetic patients. Are these patients “difficult”?

Gołębiowski, Tomasz; Weyde, Wacław; Kusztal, Mariusz; Porażko, Tomasz; Augustyniak−Bartosik, Hanna; Madziarska, Katarzyna; Krajewska, Magdalena; Koniński, P; Sydor, Antoni; Letachowicz, Krzysztof; Klinger, Marian

doi:10.5604/17322693.1164430

Cited by 11 publications

(15 citation statements)

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“…On account of atherosclerosis exists more often and severe in diabetes patients, there is a wide range of vascular lesions, making it difficult to establish a vascular access [ 28 ]. In addition, diabetes is often accompanied by hyperlipemia, hypoalbuminemia, and high blood coagulation, which also lead to AVF’s obstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies indicated atherosclerotic changes in forearm arteries in diabetic patients appear in 60% of hemodialysis patients [ 28 ]. It is possible to create a native AVF in 90% of diabetic patients, although this requires more procedures.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is difficult to create an AVF only in the remaining 10% of diabetic patients. In patients with diabetes, AVF in the wrist region should be preferred [ 28 ]. In case of fistula failure, revision is a reliable procedure salvaging a failed fistula, which yields an acceptable patency rate of regardless of the patient’s risk factors for arteriosclerosis [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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A meta-analysis of the association between diabetic patients and AVF failure in dialysis

Yan

Liu

et al. 2018

Renal Failure

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Purpose: The most preferable vascular access for patients with end-stage renal failure needing hemodialysis is native arteriovenous fistula (AVF) on account of its access longevity, patient morbidity, hospitalization costs, lower risks of infection and fewer incidence of thrombotic complications. Meanwhile, according to National Kidney Foundation (NKF)/Dialysis Out-comes Quality Initiative (DOQI) guidelines, AVF is more used than before. However, a significant percentage of AVF fails to support dialysis therapy due to lack of adequate maturity. Among all factors, the presence of diabetes mellitus was shown to be one of the risk factors for the development of vascular access failure by some authors. Therefore, this review evaluates the current evidence concerning the correlation of diabetes and AVF failure.Methods: A search was conducted using MEDLINE, SCIENCE DIRECT, SPRINGER, WILEY-BLACKWELL, KARGER, EMbase, CNKI and WanFang Data from the establishment time of databases to January 2016. The analysis involved studies that contained subgroups of diabetic patients and compared their outcomes with those of non-diabetic adults. In total, 23 articles were retrieved and included in the review.Results: The meta-analysis revealed a statistically significantly higher rate of AVF failure in diabetic patients compared with non-diabetic patients (OR = 1.682; 95% CI, 1.429–1.981, Test of OR = 1: z = 6.25, p <.001).Conclusions: This review found an increased risk of AVF failure in diabetes patients. If confirmed by further prospective studies, preventive measure should be considered when planning AVF in diabetic patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A meta-analysis of the association between diabetic patients and AVF failure in dialysis

Yan

Liu

et al. 2018

Renal Failure

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“…Diabetes is a common comorbidity associated with ESRD and, consequently, many patients on dialysis have diabetes as well [ 10 ]. Due to the deleterious effects that diabetes has on vascular anatomy, fistula creation becomes more difficult and is not always possible.…”

Section: Discussionmentioning

confidence: 99%

Salvage of Suboptimal or Occluded Arteriovenous Fistulas Using a 4 French System From the Radial Artery for Initial Balloon Angioplasty Maturations

Voto

Panetta

2021

Cureus

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Introduction End-stage renal disease (ESRD) is a condition that has seen a large increase in prevalence in recent decades. Paralleling this increase in prevalence is the increasing number of patients requiring vascular access for hemodialysis. Arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) are considered the procedures of choice for hemodialysis access. However, due to the suboptimal venous anatomy (<2 mm diameter, sclerotic vascular walls) and chronic medical conditions (diabetes mellitus) seen in many ESRD patients, successful AVF creation and maturation is not always possible using standard procedures. In this study, we performed primary balloon angioplasty (PBA) at the time of AVF creation with subsequent balloon angioplasty maturation (BAM) procedures in a group of patients with a large proportion of diabetes and suboptimal venous anatomy. The purpose of this study was to compare the assisted patency and survival rates in patients with suboptimal veins used to create AVFs to patients with standard vein AVFs and AVGs. Methods Over a nine-year period, PBA during AVF creation was performed 682 times. Of these, 551 AVFs were matured in optimally sized veins using standard BAM procedures, and 131 AVFs were matured in suboptimal veins utilizing a modified approach. In the subset of patients with suboptimal venous anatomy, we performed the initial BAM procedure via the radial artery utilizing a 4 French system. Additionally, routine clinical surveillance was scheduled throughout the study period for all patients. Suboptimal veins included small (<2 mm diameter), sclerotic, accessory, or recanalized veins. During the study period, 69 AVGs were created and matured using standard graft-gram procedures. A Kaplan-Meier analysis of survival and assisted patency rates comparing the three groups were calculated utilizing data from a retrospective database and medical records. A hazard ratio and a log-rank test were calculated to assess statistical significance. Results The mean time of follow-up for all three groups (n=703) was 43.2 months. Among patients requiring hemodialysis access in the study, the fistula creation rate was 90.8%. Patients with suitable venous anatomy who underwent AVF creation with PBA and standard BAM procedures experienced higher primary assisted patency rates relative to the suboptimal vein AVF and AVG groups (p<0.0001). No difference was seen between the suboptimal vein AVF and AVG groups. Patient survival and the percentage of diabetics were comparable amongst all three groups. Conclusion Using our approach, we were able to achieve a high AVF creation rate amongst a group of patients with a large proportion of suboptimal veins and diabetes. Despite not performing as well as standard vein AVFs in regards to primary assisted patency, the patients with suboptimal vein AVFs experienced similar patency and survival rates as compared to patients receiving AVGs. This new approach enhances the ability to cre...

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“…(Yan Y, et al, 2018). Beberapa penelitian lain menunjukkan perubahan aterosklerotik pada arteri lengan bawah pada pasien diabetes muncul pada 60% pasien hemodialysis (Gołębiowski, et al, 2015).…”

Section: Pendahuluanunclassified

Hubungan Nilai Trombosit dan Hematokrit dengan Kegagalan Arteriovenous Fistula pada Pasien Gagal Ginjal

Satria

Rustam

Rivaldy

2020

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Hemodialysis is a treatment for kidney failure that uses a machine to send the patient's blood through a filter. Arteriovenous fistulas (AVF) and arteriovenous grafts are vascular access that is designed for long-term use. In the world, the number of patients with end-stage chronic kidney failure (CRF) which requires hemodialysis is increasing. However, almost 50% of arteriovenous fistulas can never be used for hemodialysis, and if they can be used, 25% will experience failure after 2 years. Many factors make the AVF failure, between the injury of the endothelial wall or the hypercoagulation. This study uses a cross-sectional retrospective design. Data is taken from the medical record status of patients with chronic kidney failure in RSUP Dr. M.Djamil Padang from January 2017-December 2019. Data were analyzed by Chi-square and Fisher test. From a sample of 33 people, patients obtained hematocrit values <33%, 33-36%,> 36% failure of AVF as many as 8, 2, and 4 people. While the platelet values <150,000,150,000-400,000 and 400,000 obtained AVF failures were 0.9 and 5 people. There was no relationship of platelet values with AVF failure in hemodialysis patients with p-value=0,323. There was a correlation between hematocrit values and AVF failure in hemodialysis patients with p-value=0,003.

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Vascular access in diabetic patients. Are these patients “difficult”?

Cited by 11 publications

References 0 publications

A meta-analysis of the association between diabetic patients and AVF failure in dialysis

A meta-analysis of the association between diabetic patients and AVF failure in dialysis

Salvage of Suboptimal or Occluded Arteriovenous Fistulas Using a 4 French System From the Radial Artery for Initial Balloon Angioplasty Maturations

Hubungan Nilai Trombosit dan Hematokrit dengan Kegagalan Arteriovenous Fistula pada Pasien Gagal Ginjal

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