Preferred Haemodialysis Vascular Access for Diabetic Chronic Kidney Disease Patients: A Systematic Literature Review

Abstract

background: Vascular access problems are one of the main concerns in the diabetic end-stage kidney disease (ESKD) population. However, the optimal strategy for the establishement of vascular access in this population remains to be solved. We performed a systematic review in order to clarify the most advisable approach of vascular access planning in diabetic patients with ESKD. Methods: MEDLINE, EMBASE and CENTRAL databases were searched for Englishlanguage articles without time restriction through focused, high sensitive search strategies. We included all studies providing outcome data on diabetics starting chronic haemodialysis treatment on basis of the type of primary placed vascular access. Results: 13 studies in total comprising over 2800 participants with diabetes were reviewed and included in the review. We found that diabetic patients using a dialysis catheter apparently experience a higher risk of death and infection compared with patients who successfully achieved and maintained an arteriovenous fistula as dialysis access. Comparison between the use of a graft or an autogenous fistula as dialysis access generated conflicting results. Primary patency rates appeared to be lower in diabetics versus non-diabetics. Our study suggests that diabetic ESKD patients with dialysis catheters incur a higher risk of death in comparison to those who achieve an arteriovenous access. Conclusion: Our study suggests that diabetic ESKD patients with dialysis catheters incur a higher risk of death in comparison to those who achieve an arteriovenous access. It is however unclear whether this is caused by residual selection bias or by a true advantage of native vascular access

Clinical outcomes and quality of life in hemodialysis diabetic patients versus non-diabetics

“…There was a greater use of non-AVF access in diabetic women and a trend in older patients which are in accordance with other reports (24). Catheter usage with accompanying less dialysis adequacy and greater risk of infection and inflammation could potentially affect the survival of the HD patients (25). Furthermore, infections in the context of cardiovascular disease could potentially exacerbate the underlying CVD and expedite death of the HD patients.…”

Dialysis-related factors affecting self-efficacy and quality of life in patients on haemodialysis: a cross-sectional study from Palestine

“…In the last 10 years, the prevalence and frequency of ESRD has risen steadily by 4-8% per year throughout the world. Diabetes mellitus (DM) is the major predisposing factor for ESRD [5,6], accounting for nearly 44% of new cases [6][7][8]. CKD has a major effect on the individual level by increasing the morbidity and mortality of patients and also increasing healthcare costs and the demand for healthcare services on a national level [1].…”

Comparison of Primary Patency and Maturation Rate of Antecubital Artriovenous Fistula for Dialysis in Diabetic Patient with Two Methods: Regional Block with Ropivacaine 0.5% and Local Anesthesia with Lidocaine 2%

“…Vascular accesses including arteriovenous fistula are common method for dialysis (1)(2)(3) especially in patients with end-stage renal disease due to diabetes to improve the survival (4). Increased rate of diabetes and some difficulties in dialysis process is a major concern among vascular surgeons and nephrologists (1,4).…”

“…Increased rate of diabetes and some difficulties in dialysis process is a major concern among vascular surgeons and nephrologists (1,4). The best route for vascular access is a controversial matter in diabetic patients with renal failure (2). Development of a patent long-term route for dialysis in diabetic subjects with renal insufficiency is important for prognosis improvement.…”

“…Development of a patent long-term route for dialysis in diabetic subjects with renal insufficiency is important for prognosis improvement. One-fourth of hospital admissions in dialysis patients are related to vascular access (2) and the rates of mortality and infection in diabetic cases with catheter insertion are higher than cases fistula use (2). Arteriovenous fistula is preferred method for vascular access in patients under dialysis with longevity and increased wall resistance without adverse effects such as catheter fractures and infections (2).…”