Systemic lupus erythematosus diagnosis impacts clinical outcomes of arteriovenous fistulas in comparison to other end-stage renal disease etiologies

• Published in: Vascular 2021-02, Vol.29 (1), p.126-133
• Main Authors: Cuen-Ojeda, Cesar, Pascual-Ramos, Virginia, Contreras-Yáñez, Irazú, Anaya-Ayala, Javier E, Elenes-Sanchez, Erika, Rosas-Rios, Casandra, Mendez-Sosa, Miguel A, Lozano-Corona, Rodrigo, Hinojosa, Carlos A
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Arteriovenous Shunt, Surgical - adverse effects; Female; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - physiopathology; Humans; Kidney Failure, Chronic - diagnosis; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - therapy; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - diagnosis; Lupus Nephritis - diagnosis; Lupus Nephritis - etiology; Lupus Nephritis - therapy; Male; Middle Aged; Renal Dialysis - adverse effects; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Patency; Young Adult
• ISSN: 1708-5381; 1708-539X
• DOI: 10.1177/1708538120936407

Objectives Arteriovenous fistulas primary patency at one-year occurs in 43–85% of the patients with end-stage renal disease. The diagnosis attributable to end-stage renal disease has been suggested to impact arteriovenous fistulas outcomes. The objective was to compare primary patency at one week, 1, 3, 6, and 12 months of follow-ups, among systemic lupus erythematosus patients and two control groups; additionally, we evaluated the impact of systemic lupus erythematosus to predict early patency loss. Methods A retrospective review of charts from arteriovenous fistulas created between 2008 and 2017 was performed. One-hundred thirty-four patients were identified and classified according to end-stage renal disease attributable diagnosis as: systemic lupus erythematosus cases (N = 14), control-group-1 (91 patients with primarily diabetes and hypertension), and control-group-2 (29 patients with idiopathic end-stage renal disease). A case–control matched design (1:2:1) was proposed. Logistic regression analysis and Kaplan–Meier curves were used. Institutional Review Board approval was obtained. Results More systemic lupus erythematosus patients lost primary patency at 3 (28.6%) and 12 months (71.4%) than patients from control-groups-1 (vs. 3.6% and 35.7%, respectively) and -2 (vs. 0% and 14.3%, respectively), (p ≤ 0.011 for both). Days of primary patency survival were shorter in systemic lupus erythematosus patients (p = 0.003). Systemic lupus erythematosus diagnosis was the only factor associated with early patency loss, HR: 3.141, 95%CI: 1.161–8.493 (systemic lupus erythematosus diagnosis vs. control-group-1) and HR: 12.582, 95%CI: 1.582–100.035 (systemic lupus erythematosus diagnosis vs. control-group-2). Conclusions Diagnosis attributable to end-stage renal disease has a major impact on arteriovenous fistula outcomes in patients. Systemic lupus erythematosus patients have an increased risk of arteriovenous fistulas patency loss within the first six months of follow-up. Patients with idiopathic end-stage renal disease had an excellent one year arteriovenous fistula patency survival.