Document Detail


Impact of obesity on arteriovenous fistula outcomes in dialysis patients.
MedLine Citation:
PMID:  17003811     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Fistula use for dialysis is less frequent among obese than non-obese patients. This discrepancy may be due to a lower rate of fistula placement in obese patients, a higher primary failure rate (fistulas that are never usable for dialysis), or a higher secondary failure rate (fistulas that fail after being used successfully for dialysis). Using a prospective, computerized vascular access database, we identified all patients receiving a first fistula or graft at our institution during a 2-year period. The access outcomes were compared between obese (body mass index (BMI) >or=30 kg/m2) and non-obese (BMI<30 kg/m2) patients. Fistula placement was equally likely between obese and non-obese patients (47.4 vs 47.1%). The primary failure rate of fistulas was similar in both groups (46 vs 41%, P=0.45). Among those fistulas that were usable for dialysis, the secondary survival was worse in obese patients (hazard ratio 2.74; 95% confidence interval (CI), 1.48-7.90; P=0.004). Secondary fistula survival in obese vs non-obese patients was 68 vs 92% at 1 year, 59 vs 78% at 2 years, and 47 vs 70% at 3 years. On multiple variable survival analysis with age, sex, race, diabetes, coronary artery disease, peripheral vascular disease, fistula location, surgeon, and obesity in the model, obesity was the only significant factor predicting secondary fistula failure (hazards ratio 2.93; 95% CI, 1.44-5.93; P=0.004). In conclusion, long-term fistula survival is worse in obese than non-obese patients, owing to a higher secondary failure rate.
Authors:
M Kats; A M Hawxby; J Barker; M Allon
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2006-09-27
Journal Detail:
Title:  Kidney international     Volume:  71     ISSN:  0085-2538     ISO Abbreviation:  Kidney Int.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2006-12-14     Completed Date:  2007-03-07     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0323470     Medline TA:  Kidney Int     Country:  United States    
Other Details:
Languages:  eng     Pagination:  39-43     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Arteriovenous Shunt, Surgical / adverse effects*
Blood Vessel Prosthesis
Catheters, Indwelling
Female
Humans
Kidney Failure, Chronic / complications,  therapy
Male
Middle Aged
Obesity / complications*
Prospective Studies
Renal Dialysis / adverse effects
Treatment Failure
Treatment Outcome
Grant Support
ID/Acronym/Agency:
1 K24 DK59818-01/DK/NIDDK NIH HHS
Comments/Corrections
Comment In:
Kidney Int. 2007 Jan;71(1):12-4   [PMID:  17167506 ]
Nat Clin Pract Nephrol. 2007 Jun;3(6):308-9   [PMID:  17426718 ]

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