Comparison of arteriovenous fistula outcomes in patients with and without autosomal dominant polycystic kidney disease: A retrospective study

Abstract

Background:

Autosomal dominant polycystic kidney disease (ADPKD) is associated with distinct vascular remodeling; however, its impact on arteriovenous fistula (AVF) outcomes in hemodialysis patients remains unclear. This study aimed to compare AVF patency and survival between patients with and without ADPKD.

Methods:

We conducted a retrospective observational cohort study including 38 patients with ADPKD and 38 age-matched non-ADPKD patients who underwent first-time AVF creation between 2013 and 2021. Patients were followed for 24 months. Primary failure, primary patency, and assisted primary patency were assessed. Statistical analyses included Student’s t-test, chi-square test, and Kaplan–Meier survival analysis.

Results:

Compared with non-ADPKD patients, those with ADPKD had a significantly lower prevalence of diabetes mellitus (7.9% vs 52.6%, p < 0.001), ischemic heart disease (2.6% vs 31.6%, p < 0.001), and peripheral artery disease (5.3% vs 23.7%, p = 0.022). Distal AVF creation was more frequent in the ADPKD group (73.7% vs 57.9%, p = 0.147). At 24 months, primary patency was 63.2% in the ADPKD group and 60.5% in the non-ADPKD group (p = 0.81), while assisted primary patency was 84.2% and 73.7%, respectively (p = 0.26). Kaplan–Meier analysis showed no significant difference in AVF survival between groups (p = 0.22).

Conclusions:

Despite a lower burden of traditional atherosclerotic risk factors, patients with ADPKD exhibited AVF patency and survival comparable to those without ADPKD. These findings suggest that disease-specific vascular remodeling, rather than atherosclerosis alone, plays a key role in AVF outcomes. Larger prospective studies are warranted to further elucidate the mechanisms influencing vascular access performance in ADPKD.