IMPACT OF DIABETES MELLITUS ON ARTERIOVENOUS FISTULA MATURATION AND PRIMARY PATENCY IN PATIENTS UNDERGOING HEMODIALYSIS

Abstract

Background Diabetes mellitus may adversely affect arteriovenous fistula (AVF) maturation and long-term patency in patients receiving maintenance haemodialysis. This study evaluated the association between diabetes and AVF maturation, complications, and patency. Methods A single-center observational study was conducted at the Department of Cardiovascular Surgery, Imran Idrees Teaching Hospital, Sialkot, Pakistan. Consecutive eligible patients undergoing native AVF creation between 20 February 2025 and 30 January 2026 were included. Patients were categorized according to diabetes status. Demographic, clinical, vascular, operative and AVF outcome variables were compared. Kaplan–Meier analysis, multivariable logistic regression and Cox proportional-hazards regression were performed. Results Among 700 patients, 322 (46.0%) had diabetes and 378 (54.0%) did not. Successful AVF maturation was significantly lower in diabetic patients than non-diabetic patients (61.8% vs. 84.7%, p<0.001), while primary failure was higher (16.5% vs. 5.3%). Diabetic patients had longer time to maturation (63 vs. 44 days) and first successful cannulation (72 vs. 53 days), and more frequently required assisted maturation (34.5% vs. 12.2%; all p<0.001). Thrombosis, stenosis and access-related infection were also significantly more frequent among diabetic patients. Twelve-month primary patency among matured fistulas was 24.5% versus 52.5%, while secondary patency was 58.0% versus 86.6% in diabetic and non-diabetic patients, respectively. Diabetes independently predicted maturation failure (adjusted OR 4.56; 95% CI 2.21–9.44) and loss of primary patency (adjusted HR 2.62; 95% CI 2.02–3.42). Conclusion Diabetes mellitus was independently associated with impaired AVF maturation and substantially reduced patency. Diabetic patients may benefit from meticulous vascular assessment, individualized access planning and closer postoperative surveillance.