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Outcomes of autogenous fistulas and prosthetic grafts for hemodialysis access in diabetic and nondiabetic patients.
Arhuidese, Isibor J; Purohit, Aarti; Elemuo, Chiamaka; Parkerson, Godfrey Ross; Shames, Murray L; Malas, Mahmoud B.
Afiliação
  • Arhuidese IJ; Division of Vascular Surgery, University of South Florida, Tampa, Fla; Division of Vascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
  • Purohit A; Division of Vascular Surgery, Johns Hopkins Medical Institutions, Baltimore, Md.
  • Elemuo C; University of Benin Teaching Hospital, Benin City, Nigeria.
  • Parkerson GR; Division of Vascular Surgery, University of South Florida, Tampa, Fla.
  • Shames ML; Division of Vascular Surgery, University of South Florida, Tampa, Fla.
  • Malas MB; University of Benin Teaching Hospital, Benin City, Nigeria; Division of Vascular Surgery, University of California San Diego, La Jolla, Calif. Electronic address: mmalas@ucsd.edu.
J Vasc Surg ; 72(6): 2088-2096, 2020 12.
Article em En | MEDLINE | ID: mdl-32276026
ABSTRACT

BACKGROUND:

This study evaluated the effect of diabetes on outcomes of autogenous fistulas and prosthetic grafts for hemodialysis access in a large population-based cohort of patients.

METHODS:

A retrospective cohort study was conducted of all patients who initiated hemodialysis in the United States Renal Database System (2007-2014). The χ2 test, Student t-test, Kaplan-Meier analysis, log-rank test, and multivariable logistic and Cox regression analyses were employed to evaluate maturation, interventions, patency, infection, and mortality.

RESULTS:

The study of 381,622 patients comprised 303,307 (79.5%) autogenous fistulas and 78,315 (20.5%) prosthetic grafts placed in 231,134 (60.6%) diabetic patients and 150,488 (39.4%) nondiabetic patients. There was decrease in maturation for diabetics compared to nondiabetics who received autogenous fistulas (adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.83-0.88; P < .001) and prosthetic grafts (aHR, 0.88; 95% CI, 0.83-0.93; P < .001). Comparing diabetics vs nondiabetics, primary patency at 5 years was 19.4% vs 23.5% (P < .001) for autogenous fistulas and 9.1% vs 11.2% (P < .001) for prosthetic grafts. Primary assisted patency at 5 years was 35.2% vs 38.7% (P < .001) for autogenous fistulas and 17.2% vs 19.2% (P = .015) for prosthetic grafts. Secondary patency at 5 years was 44.8% vs 48.6% (P < .001) for autogenous fistulas and 34.1% vs 36.8% (P = .002) for prosthetic grafts. There was 5% decrease in primary patency (aHR, 0.95; 95% CI, 0.94-0.96; P < .001) for diabetics compared to nondiabetics who received autogenous fistulas. There was no difference in primary assisted and secondary patency for autogenous fistulas as well as primary, primary assisted, and secondary patency for prosthetic grafts in comparing diabetic to nondiabetic patients. There was also no significant difference in severe prosthetic graft infection between the groups (aHR, 0.99; 95% CI, 0.92-1.08; P = .90). There was a 19% increase in patient mortality for diabetic relative to nondiabetic autogenous fistula recipients (aHR, 1.19; 95% CI, 1.17-1.20; P < .001) and 12% increase for prosthetic graft recipients (aHR, 1.12; 95% CI, 1.10-1.15; P < .001).

CONCLUSIONS:

In this population-based cohort of hemodialysis patients, diabetes mellitus was associated with a decrease in patient survival, access maturation, and primary fistula patency. In contrast, there was no association between diabetes and prosthetic graft patency and severe prosthetic graft infection warranting excision.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Derivação Arteriovenosa Cirúrgica / Diálise Renal / Implante de Prótese Vascular / Nefropatias Diabéticas / Falência Renal Crônica Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Derivação Arteriovenosa Cirúrgica / Diálise Renal / Implante de Prótese Vascular / Nefropatias Diabéticas / Falência Renal Crônica Tipo de estudo: Diagnostic_studies / Etiology_studies / Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Female / Humans / Male / Middle aged País como assunto: America do norte Idioma: En Ano de publicação: 2020 Tipo de documento: Article