Obesity is not an obstacle for successful autogenous arteriovenous fistula creation in haemodialysis

• Published in: Nephrology, dialysis, transplantation dialysis, transplantation, 2008-04, Vol.23 (4), p.1318-1322
• Main Authors: Weyde, Waclaw, Krajewska, Magdalena, Letachowicz, Waldemar, Porazko, Tomasz, Watorek, Ewa, Kusztal, Mariusz, Banasik, Miroslaw, Gołebiowski, Tomasz, Bartosik, Hanna, Madziarska, Katarzyna, Janczak, Dariusz, Klinger, Marian
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Arteriovenous Shunt, Surgical - methods; autogenous fistula; Biological and medical sciences; Emergency and intensive care: renal failure. Dialysis management; Female; Follow-Up Studies; Humans; Intensive care medicine; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; obesity; Obesity - complications; Prospective Studies; radio-cephalic fistula; Renal Dialysis - methods; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; transposition; Treatment Outcome; vascular access
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfm739

Background. Obesity, which is often associated with diabetes, is increasingly encountered in the haemodialysed population, and this may produce difficulty in autogenous arteriovenous fistula creation. Prosthetic angioaccess or catheters, when used in place of autogenous fistulas, increase thrombotic and infectious complications in these already challenged patients. Methods. This prospective study was undertaken to assess the feasibility of autogenous arteriovenous fistula creation in 71 obese patients (BMI 34.6 ± 7.8). We performed a two-stage procedure, in which radio-cephalic fistula formation was followed by subcutaneous transposition of the venous component for safe and easy puncture. Results. Fistulas suitable for puncture, having blood flows of 799 ± 285 ml/min, and sufficient to perform adequate haemodialysis (Kt/V 1.24) were achieved in 85% of the patients. Primary patency rates were 65% and 59% at 6 and 12 months, respectively, and secondary patency rates were 83% both at 6 and 12 months. Conclusions. Obesity does not prevent successful autogenous arteriovenous fistula formation, and may protect forearm venous vessels from the iatrogenic damage that occurs before the onset of haemodialysis therapy.