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University of Kragujevac , Kragujevac , Serbia
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Arteriovenous fistula (AVF) is recommended as the ideal vascular access for hemodialysis (HD), however, there are conflicting opinions when it comes to patients with diabetes mellitus (DM). The aim of the paper was to determine the predictive parameters of AVF maturation for HD in patients with DM. The investigation was organized as a retrospective, descriptive-analytical study. The target group of our research involved 209 patients with DM, in whom AVF was created for HD. We recorded demographic and gender characteristics, location and type of AVF at the time of creation, type of anastomosis, data on the initial (a)function of the fistula, HD catheter placement, and blood pressure. Before the operation, Doppler ultrasound of the blood vessels was performed, and intraoperatively, the lumen of the artery and vein used to form the AVF was measured. We analyzed laboratory variables that were routinely controlled in our institution. Diabetics with successful maturing fistula significantly more often had proximally located AVF (p = 0.004), end-to-side anastomosis type (p = 0.036), and initial function (p = 0.001). In a univariate analysis, the brachiocephalic location of AVF (p = 0.004), end-to-side type of anastomosis (p = 0.039), and initial function of AVF (p = 0.001) were the predictive parameters of AVF maturation. Multivariable statistical analysis showed that brachiocephalic localization of AVF (p=0.021), end-to-side anastomosis type (p = 0.004), and initial function of AVF (p = 0.001) are the predictive parameters of AVF maturation in diabetics. Predictive parameters of fistula maturation, in patients with DM in our study, are the initial function of AVF, brachiocephalic location, and end-to-side anastomosis.
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