Effects of Diabetes on the Development of Arteriovenous Fistula During the First 6 Weeks

Introduction: Diabetes mellitus has historically been considered a risk factor for arteriovenous fistula (AVF) failure, although previous studies have reported conflicting results. We aimed to compare the trajectory of fistula growth, diameter, and blood flow rate, as measured by ultrasound, between patients with and without diabetes during the first 6 weeks after AVF creation. Methods: A prospective cohort study was conducted in patients undergoing AVF surgery at our center (April 2022 to April 2023). Vascular ultrasound was performed at 4 stages: preoperatively, and postoperative day 1, week 2, and week 6. Results: Patients with diabetes (n = 33) were significantly older and more likely to have arterial calcification than patients without diabetes (n = 32). Fewer patients with diabetes achieved maturation criteria for forearm AVFs than the non-diabetes group at day 1 (37.0% vs 41.6%) and week 2 (77.7% vs 91.6%), though all fistulas matured at week 6. Fistula vein diameter increased progressively in all patients and was smaller in patients with diabetes at weeks 2 ( P = .0006) and 6 ( P = .002) relative to those without. Week 2 fistula measures were more predictive than day 1 measures of week 6 levels in all patients. Conclusion: Diabetes was associated with a slower growth of fistula vein diameter and blood flow rate. Week 2 ultrasound measures were equally predictive of week 6 levels in people with and without diabetes.