Prediction model for successful radiocephalic arteriovenous fistula creation in patients with diabetic nephropathy.

Publisher: Medknow Country of Publication: Saudi Arabia NLM ID: 9436968 Publication Model: Print Cited Medium: Internet ISSN: 1319-2442 (Print) Linking ISSN: 13192442 NLM ISO Abbreviation: Saudi J Kidney Dis Transpl Subsets: MEDLINE

Publication: 2007- : Mumbai : Medknow
Original Publication: Riyadh : Saudi Center for Organ Transplantation, c1994-

Arteriovenous Shunt, Surgical*/adverse effects ; Decision Support Techniques* ; Renal Dialysis*; Diabetic Nephropathies/*therapy ; Kidney Failure, Chronic/*therapy ; Radial Artery/*surgery ; Upper Extremity/*blood supply ; Veins/*surgery; Adult ; Aged ; Clinical Decision-Making ; Diabetic Nephropathies/diagnosis ; Diabetic Nephropathies/etiology ; Female ; Humans ; India ; Kidney Failure, Chronic/diagnosis ; Kidney Failure, Chronic/etiology ; Male ; Middle Aged ; Patient Selection ; Predictive Value of Tests ; Risk Assessment ; Risk Factors ; Treatment Outcome

Arteriovenous fistula (AVF) is the most appropriate vascular access for all chronic kidney disease patients for hemodialysis. However, patients with diabetic nephropathy are at increased risk for primary failure after AVF creation, mainly due to atherosclerosis and calcification of blood vessels. We conducted this study to find out the risk factors for primary failure of radiocephalic AVF in end-stage renal disease (ESRD) patients due to diabetic nephropathy and develop a risk predicting model. This study was conducted at a tertiary care teaching hospital of South India. Patients with ESRD due to diabetic nephropathy whom underwent left radiocephalic AVF at wrist were enrolled. Risk factors for primary failure were analyzed by univariate and multivariate logistic regression models. Sixty-six patients were included in the study. Thirty-one patients had a primary failure. Independent risk factors for primary failure were palpable vessel wall of the radial artery (P = 0.003, odds ratio [OR] = 15.317), smaller radial artery diameter (P = 0.001, OR = 16.526), radial artery peak systolic velocity (PSV) <45 cm/s (P = 0.005, OR = 8.494), and linear radial artery calcification (P = 0.006, OR = 7.942). The risk predicting model obtained by adding the score given for each risk factors (vessel wall not palpable = 0, palpable = 1, no linear calcification in digital X-ray = 0, linear calcification = 1, PSV ≥45 cm/s = 0, <45 cm/s = 1 and 2.5 - radial artery diameter in mm) had an area under receiver-operating characteristic curve of 0.886. Cutoff score of 1.5 had sensitivity of 83.9% and specificity of 80.0% for primary failure. Risk predicting model for primary failure based on condition of the vessel wall on palpation, radial artery diameter, flow velocity, and calcification may be helpful for suitable patient selection.

Date Created: 20191108 Date Completed: 20200420 Latest Revision: 20200420

20240829

10.4103/1319-2442.270261

31696844