Background
Establishing reliable vascular access is critical for hemodialysis in end-stage renal
disease (ESRD). In recent years, the global health burden of ESRD has grown, matched
by a rise in prevalence of obesity. Currently, more and more arteriovenous fistulae
(AVFs) are being created for obese patients with ESRD. This is a growing concern as
creating arteriovenous (AV) access in obese ESRD patients can be more challenging
and may be associated with poorer outcomes.
Methods
We performed a literature search with multiple electronic databases. We included studies
that compared outcomes after autogenous upper extremity AVF creation between obese
and nonobese patients. The relevant outcomes were postoperative complications, outcomes
related to maturation, outcomes related to patency, and outcomes related to reintervention.
Results
We included 13 studies with a total of 305,037 patients. We found a significant association
between obesity and poorer early and late AVF maturation. Obesity was also strongly
associated with lower primary patency rates and a higher need for reintervention.
Conclusions
This systematic review found that higher body mass index and obesity are associated
with poorer AVF maturation outcomes, poorer primary patency, and higher reintervention
rates.
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Article info
Publication history
Published online: February 20, 2023
Accepted:
February 2,
2023
Received in revised form:
January 20,
2023
Received:
October 20,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
All authors declare that they have no conflicts of interest.
Identification
Copyright
© 2023 Elsevier Inc. All rights reserved.
