Sage Journals: Discover world-class research

Abstract

Background:

Obesity is common among patients with end-stage renal disease; however, its impact on vascular access (VA) outcomes remains uncertain. We aimed to evaluate the association between body mass index (BMI) and VA patency.

Methods:

We retrospectively analyzed 396 patients who underwent arteriovenous fistula (AVF) or arteriovenous graft (AVG) creation (2021–2024), stratifying them by BMI (cutoff of 30 kg/m²). Primary outcomes included primary patency and assisted primary patency, secondary patency, and patient survival.

Results:

We analyzed 396 patients (mean age 66.0 ± 14.2 years; 62.1% male). Comorbidities were frequent: hypertension 94.2%, diabetes 54.8%, coronary artery disease 35.6%, peripheral arterial disease 21.7%, cerebrovascular disease 23.0%, and cancer 25.0%. Prior kidney transplantation and renal replacement therapy were present in 12.6% and 69.9% of patients, respectively. Left-sided access and autologous access was predominated (89.9% and 68.2% each), while secondary vascular access at presentation was uncommon (6.6%). The average follow up period was 8.36 ± 9.27 months. Patients with obesity (BMI ⩾30) had significantly lower primary patency than those without obesity (25.0% vs 48.0%, p = 0.024), with comparable assisted patency and long-term outcomes. BMI ⩾30 was an independent predictor of primary patency loss (hazard ratio (HR) 1.707, p = 0.038). AVG formation was a risk factor for assisted patency failure (HR 8.983, p < 0.001).

Conclusion:

Obesity was associated with early access failure; not with long-term outcomes. Durable VA outcomes can be achieved in patients with obesity through surveillance and timely interventions.

Keywords

Vascular access primary patency body mass index arteriovenous fistula arteriovenous graft

Get full access to this article

View all access options for this article.

References

Lawson

Niklason

Roy-Chaudhury

. Challenges and novel therapies for vascular access in haemodialysis. Nat Rev Nephrol 2020; 16(10): 586–602.

Sidawy

Spergel

Besarab

, et al. The society for vascular surgery: clinical practice guidelines for the surgical placement and maintenance of arteriovenous hemodialysis access. J Vasc Surg 2008; 48(5 Suppl): 2S–25S.

Gilmore

. KDOQI clinical practice guidelines and clinical practice recommendations–2006 updates. Nephrol Nurs J 2006; 33(5): 487–488.

Ravani

Palmer

Oliver

, et al. Associations between hemodialysis access type and clinical outcomes: a systematic review. J Am Soc Nephrol 2013; 24(3): 465–473.

Roşu

Bolintineanu

Căpăstraru

, et al. Risk factor analysis in vascular access complications for hemodialysis patients. Diagnostics (Basel) 2025; 15(1): 88.

Abboud

Henrich

. Stage IV chronic kidney disease. N Engl J Med 2010; 362(1): 56–65.

Raulli

Sather

Dicken

, et al. Higher body mass index is associated with reinterventions and lower maturation rates after upper extremity arteriovenous access creation. J Vasc Surg 2021; 73(3): 1007–1015.

Miller

Tolwani

Luscy

, et al. Predictors of adequacy of arteriovenous fistulas in hemodialysis patients. Kidney Int 1999; 56(1): 275–280.

Vazquez-Padron

Allon

. New insights into dialysis vascular access: impact of preexisting arterial and venous pathology on AVF and AVG outcomes. Clin J Am Soc Nephrol 2016; 11(8): 1495–1503.

10.

Arhuidese

Obeid

Hicks

, et al. Vascular access modifies the protective effect of obesity on survival in hemodialysis patients. Surgery 2015; 158(6): 1628–1634.

11.

Farber

Imrey

Huber

, et al. Multiple preoperative and intraoperative factors predict early fistula thrombosis in the Hemodialysis Fistula Maturation Study. J Vasc Surg 2016; 63(1): 163–170.e6.

12.

Schmidli

Widmer

Basile

, et al. Editor’s choice - vascular access: 2018 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55(6): 757–818.

13.

Celebi-Onder

Schmidt

Holley

. Treating the obese dialysis patient: challenges and paradoxes. Semin Dial 2012; 25(3): 311–319.

14.

Padberg

Jr Calligaro

Sidawy

. Complications of arteriovenous hemodialysis access: recognition and management. J Vasc Surg 2008; 48(5): 55S–80S.

15.

Kats

Hawxby

Barker

, et al. Impact of obesity on arteriovenous fistula outcomes in dialysis patients. Kidney Int 2007; 71(1): 39–43.

16.

Lee

SHT

Choong

AMTL

. The effect of obesity on outcomes after arteriovenous fistulae creation: a systematic review. Ann Vasc Surg 2023; 92: 304–312.

17.

Yan

Davies

. Obesity drives secondary procedures to achieve access maturation in end-stage renal disease. J Vasc Surg 2023; 78(6): 1531–1540.e4.

18.

Anderson

Kraiss

Sarfati

, et al. Predictors of arteriovenous fistula maturation among patients with severe obesity. Ann Vasc Surg 2023; 97: 82–88.

19.

Kamata

Tomita

Iehara

. Ultrasound-guided cannulation of hemodialysis access. Ren Replace Ther 2016; 2(1): 7.

20.

Barnard

Taubman

Jennings

. Accessible autogenous vascular access for hemodialysis in obese individuals using lipectomy. Am J Surg 2010; 200(6): 798–802.

21.

Lee

Park

Yoon

, et al. Role of peribrachial fat as a key determinant of brachial artery dilatation for successful arteriovenous fistula maturation in hemodialysis patients. Sci Rep 2020; 10(1): 3841.

22.

Plumb

Adelson

Groggel

, et al. Obesity and hemodialysis vascular access failure. Am J Kidney Dis 2007; 50(3): 450–454.

23.

Guo

, et al. Oxidative stress: an essential factor in the process of arteriovenous fistula failure. Front Cardiovasc Med 2022; 9: 984472.

24.

Arhuidese

Purohit

Elemuo

, et al. Outcomes of autogenous fistulas and prosthetic grafts for hemodialysis access in diabetic and nondiabetic patients. J Vasc Surg 2020; 72(6): 2088–2096.

25.

Tordoir

JHM

Dammers

van der Sande

. Upper extremity ischemia and hemodialysis vascular access. Eur J Vasc Endovasc Surg 2004; 27(1): 1–5.

26.

Sen

Tripathi

. Dialysis access–associated steal syndromes. Semin Vasc Surg 2016; 29(4): 212–226.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB