O-187 - THE EFFECT OF PRE-OPERATIVE GLYCEMIC CONTROL ON THE OUTCOMES OF AV-FISTULA SURGERY IN DIABETIC PATIENTS

TOPIC:
Vascular Access
AUTHORS:
Hançer H. (Department of Cardiovascular Surgery, Koşuyolu High Specialization Research and Training Hospital ~ Istanbul ~ Turkey) , Hançer H. (Department of Internal Medicine, Koşuyolu High Specialization Research and Training Hospital ~ Istanbul ~ Turkey) , Yigit F. (Department of Cardiovascular Surgery, Koşuyolu High Specialization Research and Training Hospital ~ Istanbul ~ Turkey) , Kirali M.K. (Department of Cardiovascular Surgery, Koşuyolu High Specialization Research and Training Hospital ~ Istanbul ~ Turkey)
Introduction:
The aim of this study is to compare the effect of preoperative diabetes mellitus (DM) regulation on the postoperative surgical results for those undergoing an upper extremity arterio-venous fistula (AVF) creating surgery for the first time in chronic kidney disease (CKD) patients under dialysis treatment.
Methods:
Forty-one patients who underwent AV fistula creating surgery for the first time and had a preoperative diagnosis of DM were included in the study. A retrospective study was designed involving patients whose glycated hemoglobin (HbA1c) values were measured 24 hours before the surgery. Patients included in the study were divided into two groups according to their Hba1C values as with glycemic control (< 6.5 %) and without (> 6.5%) and comparison was made. Fistula maturity, surgical site infection, cellulitis, and 1-year mortality data were accepted as surgical outcomes.
Results:
68% (n=28) of the patients were male, 31.7% (n=13) were female; mean age was 59.68±9.28 years. The median HbA1c value was 6.98±1.47 (%). Hypertension was present in 76% (n=31) and dyslipidemia was present in 61% (n=25) of the patients. The rate of immature AVF was 29.3% (n=12) in the control Doppler USG examinations performed at the post-operative sixth week of all patients. Post operative cellulitis have been observed in 7.3% (n=3) of patients. Surgical site infection was detected in 9.3% (n=4) patients. The one-year mortality rate was 14.6% (n=6). There was no statistically significant difference between age, gender, hypertension, dyslipidemia, cellulitis, surgical site infection and mortality (p>0.05) with AVF immaturity. A statistically significant difference was found between HbA1c level and AVF maturation (p<0.05). The median value of HbA1c was higher in patients with immature AVF. The rate of patients with HbA1c > 6.5 (%) was 53.7% (n=22), and the rate of AVF immaturity was higher in these patients (p<0.05). In this group, the median HbA1c value of AVF immature patients was found to be 8.20±1.27. The mean HbA1c of AVF mature patients was 7.98±1.05. In the group with HbA1C < 6.5 (%), the median HbA1c value was 5.80±0.28 in the AVF-immature patients, and 5.70±0.46 in the subgroup with mature AVF.
Conclusion:
Good diabetic control demonstrated with an HbA1c of less than 6.5% may be associated with maturation of the fistula after 6-weeks of establishment of AVF. AVF creating surgery should not be avoided in diabetic CKD patients, but the surgery should be performed when the patient's diabetic regulation is under control, because it has been found to be associated with better outcomes.
References:
-Andrew C Gordon, et al. Diabetes should not disuade aretriovenous fistula formation. British Journal of Diabetes. 2016. -Yan Y, Ye D, Yang L, Ye W, Zhan D, Zhang L, Xiao J, Zeng Y, Chen Q. A meta-analysis of the association between diabetic patients and AVF failure in dialysis. Ren Fail. 2018 Nov;40(1):379-383. doi: 10.1080/0886022X.2018.1456464. PMID: 29724122; PMCID: PMC6014481.