Autogeneous Elbow Fistulas: the Effect of Diabetes mellitus on Maturation, Patency, and Complication Rates

Abstract

Objectives: diabetes mellitus is an increasingly common cause of end stage renal failure (ESRF) and the establishment of adequate permanent vascular access for dialysis is a major cause of morbidity and mortality in these patients. The aim of this study was to compare the availability of suitable vein, maturation rates, patency and complication rates of autogeneous elbow fistulas in diabetics and non-diabetics at a single centre where an autogeneous vein only policy is employed.Design: retrospective series.Patients and methods: two hundred and ninety-three elbow fistulas were attempted in 232 patients over a seven year period, [median age 60 years (range 14–94 years)], of which 210 were in non-diabetic and 83 were in diabetic patients. The diabetic group had a significantly higher proportion of male patients (p < 0.05), peripheral vascular disease and established ESRF.Results: there was a trend towards a higher technical success rate in the non-diabetic group (98% versus 93% p = 0.057). There was no significant difference between the primary failure rate, fistula maturation rate, revision rate or incidence of complications between the two groups. Diabetes had no effect on cumulative secondary fistula patency even when stratified for Type 1/Type 2 diabetes, female sex, old age or primary versus subsequent procedures.Conclusion: diabetes mellitus has no significant detrimental effect on outcome following formation of autogeneous elbow fistulas for haemodialysis.