The Effect of Obesity on Outcomes After Arteriovenous Fistulae Creation: A Systematic Review.

ABSTRACT

BACKGROUND: Establishing reliable vascular access is critical for hemodialysis in end-stage renal disease (ESRD). In recent years, the global health burden of ESRD has grown, matched by a rise in prevalence of obesity. Currently, more and more arteriovenous fistulae (AVFs) are being created for obese patients with ESRD. This is a growing concern as creating arteriovenous (AV) access in obese ESRD patients can be more challenging and may be associated with poorer outcomes. METHODS: We performed a literature search with multiple electronic databases. We included studies that compared outcomes after autogenous upper extremity AVF creation between obese and nonobese patients. The relevant outcomes were postoperative complications, outcomes related to maturation, outcomes related to patency, and outcomes related to reintervention. RESULTS: We included 13 studies with a total of 305,037 patients. We found a significant association between obesity and poorer early and late AVF maturation. Obesity was also strongly associated with lower primary patency rates and a higher need for reintervention. CONCLUSIONS: This systematic review found that higher body mass index and obesity are associated with poorer AVF maturation outcomes, poorer primary patency, and higher reintervention rates.