Obesity is an independent risk factor for primary patency loss in 12 months: A 3-year retrospective study of vascular access outcomes

Abstract

Background: Obesity is common among patients with end-stage renal disease; however, its impact on vascular access (VA) outcomes remains uncertain. We aimed to evaluate the association between body mass index (BMI) and VA patency. Methods: We retrospectively analyzed 396 patients who underwent arteriovenous fistula (AVF) or arteriovenous graft (AVG) creation (2021-2024), stratifying them by BMI (cutoff of 30 kg/m(2)). Primary outcomes included primary patency and assisted primary patency, secondary patency, and patient survival. Results: We analyzed 396 patients (mean age 66.0 +/- 14.2 years; 62.1% male). Comorbidities were frequent: hypertension 94.2%, diabetes 54.8%, coronary artery disease 35.6%, peripheral arterial disease 21.7%, cerebrovascular disease 23.0%, and cancer 25.0%. Prior kidney transplantation and renal replacement therapy were present in 12.6% and 69.9% of patients, respectively. Left-sided access and autologous access was predominated (89.9% and 68.2% each), while secondary vascular access at presentation was uncommon (6.6%). The average follow up period was 8.36 +/- 9.27 months. Patients with obesity (BMI >= 30) had significantly lower primary patency than those without obesity (25.0% vs 48.0%, p = 0.024), with comparable assisted patency and long-term outcomes. BMI >= 30 was an independent predictor of primary patency loss (hazard ratio (HR) 1.707, p = 0.038). AVG formation was a risk factor for assisted patency failure (HR 8.983, p < 0.001). Conclusion: Obesity was associated with early access failure; not with long-term outcomes. Durable VA outcomes can be achieved in patients with obesity through surveillance and timely interventions.