A Novel Factor for Primary Arteriovenous Fistula Failure Hyperinsulinism

Abstract

Introduction and Aims: Vascular access dysfunction is an important cause of morbidity for dialysis patients and a major contributor to hemodialysis cost. Increasing fistula maturation rates is still a challenge for nephrologists. A major problem with the arteriovenous fistula (AVF) is the high frequency of primary failure, either due to early thrombosis or lack of maturation. Herein, we aimed to investigate the role of hyperinsulinism as a new factor in primary AVF failure which is strongly related intimal damage. Methods: Totally 119 patients (73 M, 46 F) with a recent diagnosis of ESRD uderwent a AVF creation by vascular surgeon. Preliminary results was presented at World Congress of Nephrology 2009, Milan, Italy. The presence of thrill were recorded on first postoperative day. Functioning access was defined as successful cannulation with two needles and a minimum blood flow of 250 ml/min for at least a complete dialysis treatment after 4 weeks of AVF creation. Insulin resistance was evaluated by homeostasis model assessment (HOMA-IR) (HOMA-IR=fasting insulin (mU/L) × fasting glucose (mg/dl) /405). The significant factors differed between patients with and without primary AVF failure, were included in logistic regression analysis to demonstrate independent predictors of primary AVF failure.