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NDT Advance Access originally published online on October 23, 2007
Nephrology Dialysis Transplantation 2008 23(4):1318-1322; doi:10.1093/ndt/gfm739
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Obesity is not an obstacle for successful autogenous arteriovenous fistula creation in haemodialysis

Waclaw Weyde1, Magdalena Krajewska1, Waldemar Letachowicz1, Tomasz Porazko1, Ewa Watorek1, Mariusz Kusztal1, Miroslaw Banasik1, Tomasz Golebiowski1, Hanna Bartosik1, Katarzyna Madziarska1, Dariusz Janczak2 and Marian Klinger1

1 Department of Nephrology and Transplantation Medicine 2 Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Wroclaw, Poland

Waclaw Weyde, Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Traugutta 57/59, 50-417 Wroclaw, Poland. Tel: +48-717332505; Fax: +48-717332509; E-mail: klinef{at}am.centrum.pl



  Abstract

Background. Obesity, which is often associated with diabetes, is increasingly encountered in the haemodialysed population, and this may produce difficulty in autogenous arteriovenous fistula creation. Prosthetic angioaccess or catheters, when used in place of autogenous fistulas, increase thrombotic and infectious complications in these already challenged patients.

Methods. This prospective study was undertaken to assess the feasibility of autogenous arteriovenous fistula creation in 71 obese patients (BMI 34.6 ± 7.8). We performed a two-stage procedure, in which radio-cephalic fistula formation was followed by subcutaneous transposition of the venous component for safe and easy puncture.

Results. Fistulas suitable for puncture, having blood flows of 799 ± 285 ml/min, and sufficient to perform adequate haemodialysis (Kt/V 1.24) were achieved in 85% of the patients. Primary patency rates were 65% and 59% at 6 and 12 months, respectively, and secondary patency rates were 83% both at 6 and 12 months.

Conclusions. Obesity does not prevent successful autogenous arteriovenous fistula formation, and may protect forearm venous vessels from the iatrogenic damage that occurs before the onset of haemodialysis therapy.

Keywords: autogenous fistula; obesity; radio-cephalic fistula; transposition; vascular access

Received for publication: 5. 2.07
Accepted in revised form: 20. 9.07


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