| Background:In recent years, with the change of lifestyle and exacerbation of an aging population, the morbidity of diabetes mellitus (DM) has been increasing day by day. According to the report from International Diabetes Federation (IDF) in 2014, there were at least 387 million people worldwide with diabetes, and it was estimated that by 2035 the number would increase to 600 million. The proportion of diabetic nephropathy in patients with end stage renal disease (ESRD) is also increasing year by year. In some developed countries and regions, such as the United States, Singapore and Taiwan, diabetic nephropathy has developed into the leading cause of end stage renal disease. The studies about whether diabetes affects the maturity of autogenous Arteriovenous Fistula (AVF) in patients with ESRD is controversial abroad, but currently the related research is relatively absent at home.Objective:In this article, we observed the change of vascular diameter, the situation of fistula maturity and stenosis in the third month after operation, to investigate whether diabetes would affect the maturation of autogenous AVF in patients with ESRD.Methods:Select patients with ESRD in Nephrology Department of Beijing Haidian hospital, divide them into the diabetes group and the non-diabetic group according to whether they were accompanied with diabetes. Record their general information, primary disease and vascular calcification, decide the operation plans after comprehensive evaluation, and record the corresponding parameters of vessels ready for anastomosis. Examine the fistulas with color Doppler ultrasound in the third month after operation and record the corresponding parameters, and determine the fistula maturation combined with physical examination.Results:1 comparison of general information:The study included 118 patients, the main cause of ESRD is diabetic nephropathy(42.4%).The diabetes group included 50 cases, 34 of which were men,16 of which were women, and the average age was (59.6±10.4) years old,31 cases created left forearm fistula, another 19 cases in right forearm. The non-diabetic group included 68 cases,38 of which were men, another 30 were women, and the average age was (51.0±15.8) years old,31 cases created left forearm fistula, another 27 cases in right forearm. There were no statistically significant differences between groups on age and gender (P>0.05).The incidence of vascular calcification in diabetes was higher than that in non-diabetes, and the difference was statistically significant (P<0.05).Ultrasound examination showed the diameter of radial artery and the distensibility of cephalic vein in diabetes had no significant difference compared with the non-diabetic group (P>0.05)2 vascular diameter comparison before and after operation:Preoperative radial artery diameter in diabetes was 1.69±0.42mm,3 months after operation it became 2.88±0.47mm,but preoperative radial artery diameter in non-diabetes was 1.71±0.41 mm,3 months after operation it was 3.33±0.52 mm, the expansion degree of radial artery in diabetes was obviously less than that in non-diabetes (76.41±40.41% vs 103.07±50.77%), and the difference was statistically significant (P<0.05); preoperative cephalic vein diameter without tourniquet in diabetes was 1.53±0.40 mm,3 months after operation it became 4.52±0.79mm, but preoperative cephalic vein diameter without tourniquet in non-diabetes was 1.56±0.28 mm,3 months after operation it was 5.14±0.84 mm, the expansion degree of cephalic vein in diabetes was less than that in non-diabetes (76.41±40.41%?vs 103.07±50.77%), but the difference lost its significance (P> 0.05).3 fistula maturity:In the third month after operation, the maturation rate of study population was 85.6%. Among them, the rate in diabetes was 72%, and that in non-diabetes was 95.6%, the maturation rate in diabetes was obviously lower than that in non-diabetes, and the difference had statistical significance (P< 0.05).4 fistula stenosis:During postoperative 3-month follow-up period, the total incidence of fistula stenosis in study population was 11.9%. the incidence of fistula stenosis in diabetes was significantly higher than that in non-diabetes (16% vs 5.9%), the difference was statistically significant (P< 0.05).5 factors influencing fistula maturation:Univariate logistic regression analysis showed that diabetes mellitus and radial artery diameter<1.5mm affected autologous fistula maturation, which was statistically significant (P<0.05); Binary logistic regression analysis showed diabetes mellitus and radial artery diameter <1.5mm were the independent risk factors of fistula immaturity increase.Conclusions:1?The incidence of vascular calcification in patients with ESRD and diabetes is higher than that in patients without diabetes.2?The cephalic vein and radial artery both dilate apparently after creation of the arteriovenous fistula. The dilation of radial artery in patients with ESRD accompanied with diabetes is limited.3?The incidence of fistula stenosis and immaturity is higher in patients with ESRD and diabetes than that in non-diabetes.4?Diabetes mellitus and radial artery diameter<1.5mm influence the maturation of arteriovenous fistula, and they are independent risk factors of fistula immaturity increase. |
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