Fistula Failure Appears Higher In Groups Of CKD Including Those With Diabetes. Are You At Risk?

KidneyBuzz.com was asked, "I have been told that women, patients with diabetes, and elderly patients are not good AV Fistula candidates. Is that true?"

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The direct answer: "It's complicated." Various studies have revealed that those with Type II Diabetes have significantly worse rates of Arteriovenous (AV) Fistula success than Non-Diabetics. This may be due to nerve and blood vessel damage which are common complications caused by Diabetes. Are you surprised? Keep reading, there is more useful and eye-opening information. 

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Over the last several years, the proportion of patients older than 80 years of age with End-Stage Renal Disease has been constantly growing. Patients over the age of 80 years old, however, have been found to achieve poor rates of AV Fistula success. The American Society of Nephrology (ASN) notes that although using an AV Fistula improved "survival compared with an AV Graft in Dialysis patients in their late 60s and 70s," it did not for patients in their 80s and 90s. 

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Fistulas are currently the "Gold Standard" for all Hemodialysis patients, but evidence for its added value is lacking in elderly populations over 80 years of age. For this reason the journal, Hemodailysis International, reinforced the idea that the AV Fistula is not ideal for those who are severely elderly and may require a more careful selection and evaluation process prior to referral. As you are well aware, nothing remains constant for Chronic Kidney Disease patients so you should continually reevaluate your treatment options to pick the one best for you at any given time. 

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Another shock is that women have a much lower frequency of AV Fistula use than men. The data suggests that Fistulas are still less likely to mature in women than in men, despite routine Vein Mapping before operation and frequent attempts to salvage immature failing Fistulas.  This difference may be due, in part, to smaller blood vessel diameters in women. 

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You should note that Catheter use was linked with more than a 74% increased risk of death in patients. Unfortunately, there are no guarantees about which treatments are best for you. Still, if you fall into one of the above groups and are having difficulty with your current treatment method, perhaps you should discuss an alternative modality (Dialysis treatment type) with your Nephrologists. There are also, maintenance steps you can take to improve the likelihood of your fistula maturation. Click here for a list of useful AV Fistula exercises (http://www.kidneybuzz.com/things-chronic-kidney-disease-patients-arent-doing-maybe-killing-chances-to-prolong-their-life-line/).

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Be sure to visit KidneyBuzz.com every day for the most Breaking News & Information about how Chronic Kidney Disease and Diabetics can improve their lives. 

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References: 

"Gender Differences in Outcomes of Arteriovenous Fistulas in Hemodialysis Patients." Http://www.ncbi.nlm.nih.gov. U.S. National Library of Medicine.

"Long-term Outcome of Upper Limb Autogenous Arteriovenous Fistulas for Hemodialysis Access Al-Benna S, Deardon D, Hamilton D, El-Enin H - Saudi J Kidney Dis Transpl." Http://www.sjkdt.org/. Journal of Kidney Diseases and Transplantation.

"Arteriovenous Fistula for the 80 Years and Older Patients on Hemodialysis: Is It worth It?" Http://www.asn-interactive.org/. American Society of Nephrology.

"Re-evaluating the Fistula First Initiative in Octogenarians on Hemodialysis." Http://cjasn.asnjournals.org/. American Society of Nephrology.