title: A novel factor for primary arteriovenous fistula failure: hyperinsulinism.
abstract: BACKGROUND
  Dysfunction of vascular access is an important reason of morbidity for dialysis patients and it is a major factor affecting the economical burden of hemodialysis. The preferred type of vascular access is creation of an arteriovenous fistula (AVF). However, the problem of fistula maturation rate is still a challenge. Herein, we tried to search the role of hyperinsulinism and insulin resistance as a new predictor of primary AVF failure (pAVFF) that may be a cause of intimal damage.
  
  
  METHODS
  We included 119 patients (73 male and 46 female) with a diagnosis of end-stage renal disease (ESRD) who had undergone an AVF operation by a vascular surgeon. The AVF was examined for presence of thrill on the first postoperative day. A successful cannulation with two fistula needles with a blood flow of 250 mL/min for at least one complete dialysis session, after 4 weeks of AVF surgery was defined as functioning access. Insulin resistance in our patients was determined by the standard homeostasis model assessment (homa-IR). A logistic-regression analysis was performed to investigate the independent factors related with pAVFF.
  
  
  RESULTS
  Detection of pAVFF occurred in 27 (22.7%) patients. The presence of thrill, amount of daily proteinuria, insulin levels, homa-IR, and serum albumin levels were found to be significantly different between patients with fistula failure and those without pAVFF. The logistic-regression analysis of preoperative factors revealed the following OR (odds ratio) and 95% CI values: homa-IR 1.205 (1.063-1.366) (p = 0.004), serum albumin 0.398 (0.178-0.892) (p = 0.025), and the amount of daily proteinuria 1.307 (1.012-1.688) (p = 0.041). Even after addition of the presence of postoperative thrill on AVF, which was a postoperative strong clinical factor to the analysis, mean homa-IR and mean serum albumin continued to be independent predictors of pAVFF.
  
  
  CONCLUSIONS
  Insulin resistance or hyperinsulinism may be a significant cause of pAVFF, which emphasizes the role of endothelium in fistula dysfunction.
authors.affiliation: a Denizli State Hospital, Nephrology , Denizli , Turkey ;
authors.forename: Davut
authors.initials: D
authors.lastname: Akin
authors.affiliation: b School of Health, Artuklu University , Mardin , Turkey ;|c Division of Nephrology , Diyarbakır Training Hospital , Diyarbakir , Turkey ;
authors.forename: Sehmus
authors.initials: S
authors.lastname: Ozmen
authors.affiliation: d Department of Internal Medicine , Nusaybin State Hospital , Mardin , Turkey.
authors.forename: Ramazan
authors.initials: R
authors.lastname: Kaya
mesh_terms: D000328:Adult; D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000453:epidemiology*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology; D006435:Renal Dialysis; D012307:Risk Factors; D017211:Treatment Failure; D014421:Turkey; D014654:Vascular Patency
chemical_list: D007328:Insulin
keywords: Hyperinsulinism; arteriovenous fistula failure; endothelial dysfunction; hemodialysis; insulin resistance