Abstract: PUB218
Effect of Glycemic Control in Outcomes of Dialysis Vascular Access Surgery
Session Information
Category: Dialysis
- 803 Dialysis: Vascular Access
Authors
- Huang, Jin, Kaiser Permanente San Francisco Medical Center, San Francisco, California, United States
- Pak, Jimmy, The Permanente Medical Group Inc, Oakland, California, United States
- Cohn, Bradley R., The Permanente Medical Group Inc, Oakland, California, United States
- Shirazi, Aida, Kaiser Permanente San Francisco Medical Center, San Francisco, California, United States
- Zheng, Sijie, The Permanente Medical Group Inc, Oakland, California, United States
Background
Arteriovenous fistula (AVF) and arteriovenous graft (AVG) are the preferred dialysis accesses and one of the quality measurements. Hyperglycemia is recognized to be an independent risk factor of adverse surgical outcomes. However, it is unclear the optimal pre-surgery diabetic control and the underlying patient characteristic that are associated with adverse outcomes of AVF/AVG surgery. Currently there are no specific guidelines regarding acceptable preoperative glucose thresholds for AVF/AVG surgery nationally or regionally at Kaiser Permanente Northern California (KP NCAL).
Methods
We are conducting a retrospective cohort study of adult KP NCAL members with advanced chronic kidney disease, who underwent AVF/AVG surgery between January 1, 2013 and December 31, 2023. Pre-surgery diabetic control was measured by HgA1c, glucose or fructosamine. Patient characteristics including demographics, eGFR, comorbidity, and medications were obtained. The adverse clinical outcomes considered are operative complications (infection, hematoma, occlusion, maturation issue, open wound, steal), re-operation, all-cause ER visits, readmissions, MI and death within 30 days postop. We have designed logistic regression models to assess association between pre-surgery diabetic control and adverse clinical outcome of AVF/AVG surgery.
Results
A total of 9,981 patients with advanced CKD underwent AVF/AVG surgery. The mean age (±SD) was 65.6 (±13.4) years old, 40.4% were females, 31.9% were White, 16.1% were Asian, 11.0% Black, and 22.6% were Hispanic. Majority of patients (83.0%) had AVF surgery. The average preoperative HgA1c was 6.8 (SD 1.49, range 3.6-16.2). Our model estimates the odds ratio of adverse outcomes of AVF/AVG surgery with worsening glycemic control adjusting for patient’s demographics, eGFR, comorbidity, and medications.
Conclusion
Our study examines the surgical risks associated with hyperglycemia and aims to provide guidance regarding preoperative glucose management to improve surgical outcomes and avoid unnecessary delay of lifeline creation for patients with kidney failure requiring maintenance hemodialysis.