The Impact of Arteriovenous Access Placement on Estimated Glomerular Filtration Rate in Diabetic, Non-Diabetic Chronic Kidney Diseases Pre-Dialysis Stage 5

Abstract

Background:Chronic kidney disease (CKD) represents a significant and often deteriorating condition that can lead to the ultimate need for hemodialysis due to end-stage renal disease. In patients with CKD, creating arteriovenous access (AVA) is a routine surgical procedure. Objective: This study aimed to explore how AVA surgery affects the estimated glomerular filtration rate (eGFR) in both diabetic and non-diabetic CKD patients at pre-dialysis stage 5, emphasizing the timing and impact on renal functionality. Patients and Methods:A prospective cohort study was conducted on 100 CKD patients who underwent AVA surgery. These patients were divided into diabetic and non-diabetic groups for comparison. Comprehensive clinical evaluations, lab tests, and subsequent appointments were conducted for thorough analysis. Results: In the diabetic cohort (Group 1), there was a notable reduction in eGFR, decreasing from 11.05 ± 0.81 mL/min/1.73 m² one month prior to AVA formation to 10.00 ± 0.43 mL/min/1.73 m² three months afterward (p < 0.001). There was also an increase in serum creatinine from 6.03 ± 0.96 mg/dL to 6.80 ± 0.99 mg/dL (p < 0.001), and urea levels escalated from 211.15 ± 33.6 mg/dL to 237.85 ± 34.78 mg/dL (p < 0.001). Conversely, in the non-diabetic cohort (Group 2), a meaningful reduction in eGFR was observed, from 12.07 ± 0.87 mL/min/1.73 m² before AVA formation to 11.84 ± 0.52 mL/min/1.73 m² after three months (p = 0.004). Conclusions: The findings indicated that the insertion of AVA in patients with stage 5 CKD pre-dialysis, especially those with diabetes, significantly decreased eGFR, accompanied by rises in serum creatinine and urea levels.