PROSTHETIC FISTULA SURVIVAL AND COMPLICATIONS IN HEMODIALYSIS-PATIENTS - EFFECTS OF DIABETES AND AGE

Current trends in hemodialysis include increases in patient age, prevalence of diabetes, and use of high-efficiency dialysis. These patients often require prosthetic fistulas for vascular access. Little is known about fistula survival and complications in this setting. Hemodialysis patients at our center receiving new prosthetic fistulas between January 1, 1988 and January 1, 1991 were studied. Sixty-five prosthetic fistulas were placed in 50 nondiabetic and 73 in 51 diabetic patients. There were no differences in age, sex, race, or access type or location in patients with or without diabetes. Seventeen percent of fistulas were lost in nondiabetic compared with 32% diabetic patients (P < 0.05). Lifetable analysis showed 1- and 2-year graft survivals of 88% and 77% in nondiabetic patients and 70% and 67% in diabetic patients. A significant difference in graft survivals was found for the time interval from 100 to 600 days after fistula placement. There were 188 complications in 92 of the grafts. There was no difference in the distribution of thromboses, elevated recirculations, or infections causing the first complication in patients with or without diabetes, but complications occurred earlier in diabetic patients (175 ± 26 v 286 ± 36 days, P < 0.01). Nondiabetic patients with prosthetic fistula complications were significantly older than those without complications (64 ± 4 and 56 ± 2 years, respectively, P < 0.05). No impact of age on complications was found in diabetic patients. The probability of a first thrombosis at 6 and 12 months was 29% and 49% in nondiabetic and 55% and 72% in diabetic patients (P < 0.05). Older age was associated with prosthetic fistula complications in nondiabetic patients. Fistula loss and complications occur earlier in diabetic compared with nondiabetic patients. These factors should be considered in studies evaluating prosthetic fistula survival and complications. © 1992, National Kidney Foundation. All rights reserved. All rights reserved.