Comparison of Intima-Media-Thichness, Brachialic Artery VF and VF Draining Vein CKD with Diabetes and Non-Diabetes Performed AVF-Brachiosephiccia at RSCM
Main Article Content
Brachiocephalic arteriovenous fistula (AVF) is the recommended vascular access for long-term hemodialysis. However, AVF failure rates remain high, particularly among patients with diabetes mellitus (DM). Diabetes contributes to vascular structural changes, such as increased intima-media thickness (IMT) and reduced volume flow (VF), which may affect AVF maturation success. To compare changes in IMT, brachial artery volume flow, and draining vein volume flow in chronic kidney disease (CKD) patients with and without DM who underwent brachiocephalic AVF creation. This was a retrospective cohort study conducted at Cipto Mangunkusumo National General Hospital between April and June 2025. A total of 42 CKD patients were enrolled and divided into two groups: 21 with DM and 21 without DM. IMT and volume flow were measured using Doppler ultrasound at weeks 0, 2, and 6 after AVF creation. Data were analyzed using the Mann-Whitney test and independent T-test, depending on data distribution. Forty two participants met the inclusion criteria. No significant differences were found between the DM and non-DM groups regarding changes in brachial artery IMT (p = 0.918), brachial artery volume flow (p = 0.538), or draining vein volume flow (p = 0.642) at week 6. Although both groups showed a trend of increased VF from week 0 to week 6, the differences were not statistically significant. There were no significant differences in changes in IMT, brachial artery volume flow, or draining vein volume flow between CKD patients with and without DM following brachiocephalic AVF creation.
Keywords:
Brachiocephalic AVF, intima-media thickness, volume flow, diabetes mellitus, chronic kidney disease
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Pratama, D., Wasisto, O., Kekalih, A., Suhartono, R., Muradi, A., Ferian, M. F., Jayadi, A., Arifin, E., & Irawan, H. (2024). The relationship between post-anastomosis brachial artery flow rate and brachiocephalic arteriovenous fistula access maturity in end-stage kidney disease patients with diabetes mellitus. Ultrasound: Journal of the British Medical Ultrasound Society, 1742271X241287926. https://doi.org/10.1177/1742271X241287926
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Santosa, R., Rustam, R., & Rivaldy, V. (2021). Differences in arteriovenous fistula maturation between diabetes mellitus and non-diabetes mellitus in chronic renal failure patients in Padang. Bioscientia Medicina: Journal of Biomedicine and Translational Research, 6(1), 704–715. https://doi.org/10.32539/bsm.v6i1.314
Saputra, A., Kekalih, A., & Jayadi, A. (2022). Prediktor skoring maturasi arteriovenous fistula brakiosefalika sebagai akses vaskular pada pasien hemodialisis [Master's thesis, Fakultas Kedokteran Universitas Indonesia]. UI Library. https://lib.ui.ac.id/detail?id=20519863&lokasi=lokal
Schinstock, C. A., Albright, R. C., Williams, A. W., Dillon, J. J., Bergstralh, E. J., Jenson, B. M., McCarthy, J. T., & Nath, K. A. (2011). Outcomes of arteriovenous fistula creation after the fistula first initiative. Clinical Journal of the American Society of Nephrology, 6(8), 1996–2002. https://doi.org/10.2215/CJN.11251210
Siddiqui, M. A., Ashraff, S., & Carline, T. (2017). Maturation of arteriovenous fistula: Analysis of key factors. Kidney Research and Clinical Practice, 36(4), 318–328. https://doi.org/10.23876/j.krcp.2017.36.4.318
Vo, A. T., Nguyen, Q. N. H., & Le, T. (2024). Effects of diabetes on the development of arteriovenous fistula during the first 6 weeks. Journal for Vascular Ultrasound, 15443167241298060. https://doi.org/10.1177/15443167241298060
Yan, Y., Ye, D., Yang, L., Ye, W., Zhan, D., Zhang, L., Xiao, J., Zeng, Y., Chen, Q., & Tang, S. (2018). A meta-analysis of the association between diabetic patients and AVF failure in dialysis. Renal Failure, 40(1), 379–383. https://doi.org/10.1080/0886022X.2018.1456463
Young, O. K., Yeong, J. C., Ji, I. K., Young, S. K., Byung, S. K., Chul, W. P., & Noh, J. W. (2006). The impact of intima-media thickness of radial artery on early failure of radiocephalic arteriovenous fistula in hemodialysis patients. Journal of Korean Medical Science, 21(2), 284–289. https://doi.org/10.3346/jkms.2006.21.2.284
Bahrami-Ahmadi, A., Zadeh, M. K., Chehrehgosha, H., & Abbasi, M. (2022). Early failure of arteriovenous fistula (AVF): The effect of diabetes and hypertension in a cross-sectional study. Medical Journal of the Islamic Republic of Iran, 36(1), 85. https://doi.org/10.47176/mjiri.36.85
Bikbov, B., Purcell, C. A., Levey, A. S., Smith, M., Abdoli, A., Abebe, M., Adebayo, O. M., Afarideh, M., Agarwal, S. K., Agudelo-Botero, M., Ahmadian, E., Al-Aly, Z., Alipour, V., Almasi-Hashiani, A., Al-Raddadi, R. M., Alvis-Guzman, N., Amini, S., Andrei, T., Andrei, C. L., ... Murray, C. J. L. (2020). Global, regional, and national burden of chronic kidney disease, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 395(10225), 709–733. https://doi.org/10.1016/S0140-6736(20)30045-3
Bylsma, L. C., Gage, S. M., Reichert, H., Dahl, S. L. M., & Lawson, J. H. (2017). Arteriovenous fistulae for haemodialysis: A systematic review and meta-analysis of efficacy and safety outcomes. European Journal of Vascular and Endovascular Surgery, 54(4), 513–522. https://doi.org/10.1016/j.ejvs.2017.06.024
Charles, C., & Ferris, A. H. (2020). Chronic kidney disease. Primary Care: Clinics in Office Practice, 47(4), 585–595. https://doi.org/10.1016/j.pop.2020.08.001
Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic kidney disease diagnosis and management: A review. JAMA, 322(13), 1294–1304. https://doi.org/10.1001/jama.2019.14745
Elamurugan, E., & Hemachandar, R. (2017). Brachiocephalic arteriovenous fistula for hemodialysis through the median antecubital vein. Indian Journal of Nephrology, 27(3), 185–187. https://doi.org/10.4103/0971-4065.202399
Hentschel, D. M. (2018). Determinants of arteriovenous fistula maturation. Clinical Journal of the American Society of Nephrology, 13(7), 1066–1067. https://doi.org/10.2215/CJN.04050318
Intima-media thickness (IMT). (n.d.). STROKE MANUAL. Retrieved July 15, 2024, from https://www.stroke-manual.com/intima-media-thickness-imt/
Ismail, M. T., Hariawan, H., Wardhani, Y., Puspitasari, M., Artayasa, I. P. A., Ramadhan, G., Dewi, N. N. K., Gunawan, I. G. N., Wijaya, D. M., & Wiargitha, I. K. (2021). Prevalence and risk factors of arterio-venous fistula obstruction on patient with chronic kidney disease. ACI (Acta Cardiologia Indonesiana), 7(2), 53–60. https://doi.org/10.22146/aci.62479
Islam, S., Hossain, S., Hossain Pramanik, S., Aziz, T., Hakim, A., Rahman, M., Bari, M. S., Islam, M. R., & Hassan, M. Z. (2023). Diabetes mellitus affecting arteriovenous fistula (AVF). The Planet, 7(02), 22–28. https://doi.org/10.38032/planet.2023.07.02.003
Lee, J., Lee, S., Chang, J. W., Kim, S. W., & Song, J. K. (2020). Clinical value of intraoperative flow measurements of brachiocephalic arteriovenous fistulas for hemodialysis. Korean Journal of Thoracic and Cardiovascular Surgery, 53(3), 132–138. https://doi.org/10.5090/kjtcs.2020.53.3.132
Mohamed, E. A., Elsayed, M. A., Mohamed, M. A. E., & Amin, M. A. F. (2023). Impact of diabetes mellitus in arteriovenous fistula dysfunction in patients on regular hemodialysis. Al-Azhar International Medical Journal, 4(9), 157–162. https://doi.org/10.21608/aimj.2023.219090.2154
Mure?an, A. V., Florea, E., Arb?na?i, E. M., Bartus, R., Arb?na?i, E. M., Ion, A. P., Russu, E., Kaller, R., Suciu, B. A., Hosu, A. P., & Ciucanu, C. C. (2024). Elevated leukocyte glucose index is associated with long-term arteriovenous fistula failure in dialysis patients. Journal of Clinical Medicine, 13(7), 1947. https://doi.org/10.3390/jcm13071947
Oliver, M. J. (2018). The science of fistula maturation. Journal of the American Society of Nephrology, 29(11), 2668–2670. https://doi.org/10.1681/ASN.2018090939
Pratama, D., Wasisto, O., Kekalih, A., Suhartono, R., Muradi, A., Ferian, M. F., Jayadi, A., Arifin, E., & Irawan, H. (2024). The relationship between post-anastomosis brachial artery flow rate and brachiocephalic arteriovenous fistula access maturity in end-stage kidney disease patients with diabetes mellitus. Ultrasound: Journal of the British Medical Ultrasound Society, 1742271X241287926. https://doi.org/10.1177/1742271X241287926
Provenzano, M., Coppolino, G., Faga, T., Garofalo, C., Serra, R., & Andreucci, M. (2019). Epidemiology of cardiovascular risk in chronic kidney disease patients: The real silent killer. Reviews in Cardiovascular Medicine, 20(4), 209–220. https://doi.org/10.31083/j.rcm.2019.04.548
Riset Kesehatan Dasar (Riskesdas). (2018). Peran pemerintah dalam pencegahan dan pengendalian gangguan ginjal pada anak. Badan Penelitian dan Pengembangan Kesehatan Kementerian RI. https://p2ptm.kemkes.go.id/uploads/VHcrbkVobjRzUDN3UCs4eUJ0dVBndz09/2018/11/Paparan_dr_Cut_Putri_Arianie_MH_Kes_Direktur_P2PTM_Media_Briefing_Kenali_Gangguan_Ginjal_Pada_Anak_13_November_2018.pdf
Santosa, R., Rustam, R., & Rivaldy, V. (2021). Differences in arteriovenous fistula maturation between diabetes mellitus and non-diabetes mellitus in chronic renal failure patients in Padang. Bioscientia Medicina: Journal of Biomedicine and Translational Research, 6(1), 704–715. https://doi.org/10.32539/bsm.v6i1.314
Saputra, A., Kekalih, A., & Jayadi, A. (2022). Prediktor skoring maturasi arteriovenous fistula brakiosefalika sebagai akses vaskular pada pasien hemodialisis [Master's thesis, Fakultas Kedokteran Universitas Indonesia]. UI Library. https://lib.ui.ac.id/detail?id=20519863&lokasi=lokal
Schinstock, C. A., Albright, R. C., Williams, A. W., Dillon, J. J., Bergstralh, E. J., Jenson, B. M., McCarthy, J. T., & Nath, K. A. (2011). Outcomes of arteriovenous fistula creation after the fistula first initiative. Clinical Journal of the American Society of Nephrology, 6(8), 1996–2002. https://doi.org/10.2215/CJN.11251210
Siddiqui, M. A., Ashraff, S., & Carline, T. (2017). Maturation of arteriovenous fistula: Analysis of key factors. Kidney Research and Clinical Practice, 36(4), 318–328. https://doi.org/10.23876/j.krcp.2017.36.4.318
Vo, A. T., Nguyen, Q. N. H., & Le, T. (2024). Effects of diabetes on the development of arteriovenous fistula during the first 6 weeks. Journal for Vascular Ultrasound, 15443167241298060. https://doi.org/10.1177/15443167241298060
Yan, Y., Ye, D., Yang, L., Ye, W., Zhan, D., Zhang, L., Xiao, J., Zeng, Y., Chen, Q., & Tang, S. (2018). A meta-analysis of the association between diabetic patients and AVF failure in dialysis. Renal Failure, 40(1), 379–383. https://doi.org/10.1080/0886022X.2018.1456463
Young, O. K., Yeong, J. C., Ji, I. K., Young, S. K., Byung, S. K., Chul, W. P., & Noh, J. W. (2006). The impact of intima-media thickness of radial artery on early failure of radiocephalic arteriovenous fistula in hemodialysis patients. Journal of Korean Medical Science, 21(2), 284–289. https://doi.org/10.3346/jkms.2006.21.2.284
