Looking into the effect of Diabetes Mellitus on Vascular Access in Haemodialysis Patients

Introduction: The creation and maintenance of a good vascular access is mandatory for a successful haemodialysis sessions and the survival of a Chronic Kidney Disease patient. Aim: The aim of the present cross-sectional study was to look into the vascular access complications in haemodialysed patients with or without Diabetes Mellitus (DM) and to find any possible correlation of these complications with Diabetes Mellitus. Methods: For this cross-sectional study data from patients' records of private Dialysis Unit (n=77) and a big General Hospital in a Northern Greece city (n=33) were studied. Demographics, data on medication therapy and vascular access (area, type, dialysis parameters and complications) were recorded. Statistical analysis was performed with SPSS 20.0. Results: The sample was 66.7 (±12.5) years old, mainly male (58%, n=58) and on dialysis for 37.3 (±34.3) months. DM was the primary disease of 53% (n=53) of the patients and Hypertension for 13% (n=13), whereas the mean of comorbidities was 5,3 (±2,6). Thirty-seven patients (37%) had more than one VA created or placed. On the total of the sample (n=100) 156 VA were accessed with the 63% (n=63) of them with arteriovenous fistula (AVF), 35% (n=35) with central venous catheter (CVC) and 2% (n=2) with arteriovenous graft (AVG). A statistical significance (U=2560,5, p=0,1) was found regarding the number of VA of the two group of patients (DM=2,2 VA, non DM=1,8). On survival analysis it was found that DM increases the relative risk of “death” of a VA with odds ratio of 1,7 (95% confidence interval 1,1-2,6). Conclusions: DM, as primary disease or co-morbidity, in haemodialysis patients affects negatively the VA survival. Effective blood glucose control, management and methods of puncturing VA play a crucial role in maintaining the VA in DM haemodialysis patients.