Impact of comorbidities and preoperative vascular assessment on outcomes of arteriovenous fistulas in patients on haemodialysis: a retrospective cohort study

Abstract

Background: End-stage renal disease is a major global health problem, and hemodialysis remains the most common renal replacement therapy. Arteriovenous fistula (AVF) is considered the gold-standard vascular access due to its superior patency and lower complication rates. However, AVF success depends on multiple factors, including vascular anatomy and patient comorbidities. Despite careful planning, a significant proportion of fistulas fail to mature or lose function over time. This study aimed to evaluate the impact of comorbidities and preoperative vascular assessment on AVF outcomes and to determine the relationship between vessel diameter and AVF success. Methods: A retrospective cohort study was conducted at AIIMS Rishikesh including 150 adult chronic kidney disease (CKD) patients who underwent AVF creation. Data regarding demographics, comorbidities, duplex ultrasound findings, surgical details, complications, and patency outcomes were collected and analyzed statistically. Results: The mean age was 48.2 years, with male predominance. Overall primary AVF success was 68.7%. Larger arterial and venous diameters were significantly associated with higher success rates, especially when both were ≥2 mm. Primary patency declined from 78% at 3 months to 45.1% at 12 months. Early thrombosis and failure to mature were the leading causes of primary failure. Diabetes and coronary artery disease (CAD), cerebrovascular accident (CVA), peripheral arterial disease (PAD) significantly reduced AVF success. Conclusions: Preoperative vessel diameter is the strongest predictor of AVF success, while diabetes and systemic vascular disease negatively affect outcomes, emphasizing the importance of vascular assessment and comorbidity optimization.