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 (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.