title: Preferred haemodialysis vascular access for diabetic chronic kidney disease patients: a systematic literature review.
abstract: BACKGROUND
  Vascular access problems are one of the main concerns in the diabetic end-stage kidney disease (ESKD) population. However, the optimal strategy for the establishment of vascular access in this population remains to be solved. We performed a systematic review in order to clarify the most advisable approach of vascular access planning in diabetic patients with ESKD.
  
  
  METHODS
  MEDLINE, EMBASE and CENTRAL databases were searched for English-language articles without time restriction through focused, high-sensitive search strategies. We included all studies providing outcome data on diabetics starting chronic haemodialysis treatment on the basis of the type of primary placed vascular access.
  
  
  RESULTS
  A total of 13 studies comprising over 2,800 participants with diabetes were reviewed in detail and included in the review. We found that diabetic patients using a dialysis catheter apparently experience a higher risk of death and infection compared with patients who successfully achieved and maintained an arteriovenous fistula as dialysis access. The comparison between the use of a graft or an autogenous fistula as dialysis access generated conflicting results. Primary patency rates appeared to be lower in diabetics versus non-diabetics.
  
  
  CONCLUSIONS
  Our study suggests that diabetic ESKD patients with dialysis catheters incur a higher risk of death in comparison to those who achieve an arteriovenous access. It is however unclear whether this is caused by residual selection bias or by a true advantage of native vascular access.
authors: Nephrology and Infectious Diseases Research and Development Group, INEB-(I3S), University of Porto, Porto - Portugal.
authors: Luís
authors: L
authors: Coentrão
authors: Wim
authors: W
authors: Van Biesen
authors: Ionut
authors: I
authors: Nistor
authors: Jan
authors: J
authors: Tordoir
authors: Maurizio
authors: M
authors: Gallieni
authors: Anna
authors: A
authors: Marti Monros
authors: Davide
authors: D
authors: Bolignano
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects / Q000401:mortality; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000401:mortality; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006801:Humans; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency