Comparison of Early Outcome of Arteriovenous Fistula for Dialysis Access among Diabetic and Non-Diabetic Patients: A Comparative Prospective Observational Study: Arteriovenous Fistula for Dialysis Access among Diabetic and Non-Diabetic Patients

Ismail Akbar; Danish Naveed; Adnan Tahir; Mehvish Nazneen; Hina Ismail

doi:10.54393/pbmj.v9i9.1475

Authors

Ismail Akbar Department of General Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan
Danish Naveed Department of Cardiovascular Surgery, Ayub Medical College, Abbottabad, Pakistan
Adnan Tahir Department of Cardiac Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Mehvish Nazneen Department of Cardiovascular Surgery, Ayub Teaching Hospital, Abbottabad, Pakistan
Hina Ismail Department of Medicine, University Hospital, Limerick, Ireland

DOI:

https://doi.org/10.54393/pbmj.v9i9.1475

Keywords:

Arteriovenous Fistula, Hemodialysis Access, Diabetes Mellitus, Fistula Maturation, Dialysis, Complications

Abstract

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, but early maturation failure and postoperative complications remain important concerns. Diabetes mellitus may affect vascular remodeling and has been considered a potential risk factor for adverse AVF outcomes, though evidence remains inconsistent. Objective: To compare the early outcomes of AVF creation for hemodialysis access among diabetic and non-diabetic patients. Methods: This comparative prospective observational study was conducted at the Department of Cardiovascular Surgery, Ayub Teaching Hospital, from April 2025 to March 2026. A total of 254 patients undergoing AVF creation were included through non-probability consecutive sampling. Patients were grouped according to diabetic status. Early outcomes assessed included AVF maturation, thrombosis, infection, hematoma formation, and AVF failure. Data were analyzed using the chi-square test and independent-samples t-test, with p≤0.050 considered significant. Results: Mean age was 48.3 ± 17.8 years; 117 (46.1%) patients were diabetic, and 137 (53.9%) were non-diabetic. Early maturation occurred in 56.4% of diabetic and 54.7% of non-diabetic patients (p=0.742). Thrombosis (45.3% vs 44.5%, p=0.881), infection (49.6% vs 53.3%, p=0.571), and AVF failure (46.2% vs 46.7%, p=0.932) were comparable between groups. Hypertension, smoking, and radiocephalic fistula type showed significant association with AVF failure. Conclusions: Early AVF outcomes were comparable between diabetic and non-diabetic patients. Diabetes was not significantly associated with poorer early AVF outcomes in this cohort.

References

Jeong S, Kwon H, Chang JW, Kim MJ, Ganbold K, Han Y et al. Comparison of Outcomes Between Type 2 Diabetic and Non-Diabetic Incident Hemodialysis Patients with Functioning Arteriovenous Fistulas. Medicine. 2019 Nov; 98(48): e18216. doi: 10.1097/MD.0000000000018216.

Tanaka K, Nishijima K, Furuya KI, Shin S, Kai M. Risk assessment of Arteriovenous Fistulas Focusing on the Relationships Between the Properties of Shunted Blood Flow Sounds and a Medical/Surgical History of Hemodialysis Patients. PLOS ONE. 2025 May; 20(5): e0324747. doi: 10.1371/journal.pone.0324747.

Jager KJ, Kovesdy C, Langham R, Rosenberg M, Jha V, Zoccali C. A Single Number for Advocacy and Communication—Worldwide More Than 850 million Individuals Have Kidney Diseases. Nephrology Dialysis Transplantation. 2019 Nov; 34(11): 1803-5. doi: 10.1093/ndt/gfz174.

National Institute of Diabetes and Digestive and Kidney Diseases. Annual Data Report: End-stage renal disease. 2024. https://usrds-adr.niddk.nih.gov/2024/end-stage-renal-disease.

Masakane I, Taniguchi M, Nakai S, Tsuchida K, Goto S, Wada A et al. Annual Dialysis Data Report 2015, JSDT Renal Data Registry. Renal Replacement Therapy. 2018 Mar; 4(1): 19. doi: 10.1186/s41100-018-0149-8.

Lu E, Baril DT, Arbabi CN, Chou EL, Azizzadeh A, Gupta N. Outcomes of Prosthetic Upper Arm Arteriovenous Graft Vs Brachiobasilic Fistula for Hemodialysis Access. Journal of Vascular Surgery. 2024 Oct; 80(4): 1083-9. doi: 10.1016/j.jvs.2024.05.046.

Khanfar O, Aydi R, Saada S, Shehada M, Hamdan Z, Sawalmeh O et al. Mid-Term Cumulative Patency of Fistula and PTFE Grafts Among Hemodialysis Patients: A Retrospective, Single-Center Study from Palestine. The Journal of Vascular Access. 2023 Jul; 24(4): 559-67. doi: 10.1177/11297298211040988.

Beyazal M and Kaba E. Effectiveness of Endovascular Treatment in Native Hemodialysis Fistula Dysfunction: Long-Term Outcomes. Journal of Clinical Medicine. 2025 Jun; 14(12): 4382. doi: 10.3390/jcm14124382.

El Hendawy KA, Lotfi UA, Hussein MM, Eldesouky M, Nagi MM. Endovascular Treatment of Failing Arteriovenous Fistula for Hemodialysis. Systematic Reviews in Pharmacy. 2021; 12: 259-64.

Mingxi LU, Weiwei XI, Haolu CH, Huiying YA, Hua LI. Ultrasound-Guided Nitinol Stent Implantation in Treatment of Early Recurrent Stenosis of Arteriovenous Fistula. Journal of Zhejiang University (Medical Sciences). 2021 Dec; 50(6): 770. doi: 10.3724/zdxbyxb-2021-0121.

Minici R, Venturini M, Guzzardi G, Fontana F, Coppola A, Piacentino F et al. A Multicenter Retrospective Study Evaluating Distal Radial Access vs. Conventional Transradial or Transvenous Access for Endovascular Treatment of Malfunctioning Dialysis Fistulas. Life. 2024 Oct; 14(11): 1382. doi: 10.3390/life14111382.

Raksasuk S, Naweera W, Rojwatcharapibarn S, Srithongkul T. Comparing Non-Invasive Diagnostic Methods for Arteriovenous Fistula Stenosis: A Prospective Study. S. Raksasuk et al. Journal of Ultrasound. 2023 Sep; 26(3): 687-93. doi: 10.1007/s40477-022-00731-x.

Ekart R, Varda L, Vodošek Hojs N, Dvoršak B, Piko N, Bevc S et al. Early Detection of Arteriovenous Fistula Stenosis in Hemodialysis Patients Through Routine Measurements of Dialysis Dose (Kt/V). Blood Purification. 2022 Jan; 51(1): 15-22. doi: 10.1159/000514939.

Mark PB, Stafford LK, Grams ME, Aalruz H, Abd ElHafeez S, Abdelgalil AA et al. Global, Regional, and National Burden of Chronic Kidney Disease in Adults, 1990–2023, and Its Attributable Risk Factors: A Systematic Analysis for the Global Burden of Disease Study 2023. The Lancet. 2025 Nov; 406(10518): 2461-82.

Khan A, Cheema MF, Fatima R, Cheema SS, Butt Z, Gillani S et al. Prevalence of Chronic Kidney Disease in a High-Risk Population in Urban Lahore, Pakistan: A Cross-Sectional Study. Cureus. 2024 Jun; 16(6). doi: 10.7759/cureus.63296.

Im S. Pakistan Renal Registry: Annual Report 2024. Pakistan Journal of Kidney Diseases. 2025 Mar; 9(1): 3-26. doi: 10.53778/pjkd91298.

Santosa R, Rustam R, Rivaldy V. Differences in Arteriovenous Fistula Maturation Between Diabetes Mellitus and Non-Diabetes Mellitus in Chronic Renal Failure Patients in Padang. Bioscientia Medicina: Journal of Biomedicine and Translational Research. 2022; 6(1): 1287-91.

Richards J, Summers D, Sidders A, Allen E, Hossain MA, Paul S et al. Doppler Ultrasound Surveillance of Recently Formed Hemodialysis Arteriovenous Fistula: The SONAR Observational Cohort Study. Health Technology Assessment (Winchester, England). 2024 May; 28(24): 1. doi: 10.3310/YTBT4172.

Grochowina M, Leniowska L, Gala-Błądzińska A. The Prototype Device for Non-Invasive Diagnosis of Arteriovenous Fistula Condition Using Machine Learning Methods. Scientific Reports. 2020 Oct; 10(1): 16387. doi: 10.1038/s41598-020-72336-5.

Ota K, Nishiura Y, Ishihara S, Adachi H, Yamamoto T, Hamano T. Evaluation of Hemodialysis Arteriovenous Bruit by Deep Learning. Sensors. 2020 Aug; 20(17): 4852. doi: 10.3390/s20174852.

Poushpas S, Normahani P, Kisil I, Szubert B, Mandic DP, Jaffer U. Tensor Decomposition and Machine Learning for the Detection of Arteriovenous Fistula Stenosis: An Initial Evaluation. PLOS ONE. 2023 Jul; 18(7): e0286952. doi: 10.1371/journal.pone.0286952.

Zhou G, Chen Y, Chien C, Revatta L, Ferdous J, Chen M et al. Deep Learning Analysis of Blood Flow Sounds to Detect Arteriovenous Fistula Stenosis. Nature Partner Journal: Digital Medicine. 2023 Sep; 6(1): 163. doi: 10.1038/s41746-023-00894-9.