Korean J Nephrol.  2003 Jul;22(4):397-404.

The Relationship between Early Vascular Access Failure and Cardiovascular Mortality in Hemodialysis Patients with Diabetes Mellitus

• Kim YO
• Yoon SA
• Song HC
• Hur KH
• Yang CW
• Jin DC
• Kim YS
• Kim SY
• Choi EJ
• Chang YS
• Bang BK

Abstract

BACKGROUND
Although the exact mechanism in which vascular access failure frequently occurs in hemodialysis patients with diabetes mellitus is not well known, it is considered to be associated with the poor quality of the vessel at the vascular access operation sites. Therefore, vascular access failure may be associated with cardiovascular mortality in the diabetic patients, but it is not reported yet. We studied the impact of early vascular access failure on the cardiovascular morbidity in the hemodialysis patients with diabetes mellitus. METHODS: This retrospective study enrolled 144 patients who received vascular access operation between January, 1995 and December, 2000 at Uijongbu St. Mary's Hospital. We investigated vascular access failure within 1 year after the access operation and evaluated the cardiovascular death until December, 2002. We analyzed the cardiovascular mortality between early vascular failure group and patent group using Kaplan-Meier method and log rank test. RESULTS: The mean age of the patients was 58+/-11 years and the number of male was 57 (39.6%). Early vascular access failure developed in 68 patients (47.2%). During 32+/-20 months of mean follow-up period, there was 62 cardiovascular deaths. The follow-up period tended to be shorter in the access failure group (n=68) than the patent group (n= 76) (29+/-17 months vs 35+/-22 months, p=0.07). But the access failure group had higher incidence of acute myocardial infarction (13.2% vs 3.9%, p=0.044), congestive heart failure (70.5% vs 13.1%, p< 0.001), and peripheral arterial disease (20.5% vs 3.9%, p= 0.002), compared to the patent group. The cardiovascular mortality of the access failure group was higher than that of the patent group (3 year; 54.6% vs 24.6%, 5 year; 77.0% vs 42.3%, p=0.005). CONCLUSION: This data suggest that early vascular access failure is associated with the cardiovascular morbidity and mortality in hemodialysis patients with diabetes mellitus.

Keyword

Diabetes mellitus; Hemodialysis; Vascular access failure; Cardiovascular mortality

MeSH Terms

Diabetes Mellitus*
Follow-Up Studies
Heart Failure
Humans
Incidence
Male
Mortality*
Myocardial Infarction
Peripheral Arterial Disease
Renal Dialysis*
Retrospective Studies