Clinical Correlation Between Preoperative Nutrition Status and AVF Surgical Outcome in Chronic Kidney Disease (CKD) Stage 5 Patients
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Abstract
Background: Preoperative nutritional status is an important factor influencing the surgical success of arteriovenous fistula (AVF) formation in patients with Stage 5 chronic kidney disease (CKD). Protein malnutrition is a key determinant of surgical failure in this patient population. Objective: To investigate the clinical correlation between preoperative nutritional status and AVF surgical outcomes in Stage 5 CKD patients, focusing on protein intake and its effect on AVF failure rates. Methods: A prospective, multicenter study was conducted from June 2023 to June 2024 at a private hospital in Rajshahi Division. A total of 162 Stage 5 CKD patients were included. Nutritional status was assessed using serum albumin levels, BMI, protein intake (g/kg/day), and total lymphocyte count. Patients were categorized based on protein intake (<0.8 g/kg/day vs. ≥0.8 g/kg/day). AVF surgical outcomes were tracked at 4-, 12-, and 24-weeks post-surgery. Statistical analysis included calculation of means, standard deviations (SD), and p-values. Results: The overall AVF failure rate was 8.9%. Patients with restricted protein intake (<0.8 g/kg/day) exhibited a failure rate of 18.2%, significantly higher than the 5.6% failure rate in patients with adequate protein intake (≥0.8 g/kg/day) (p = 0.003). Serum albumin levels were lower in the restricted protein group (mean = 3.1 g/dL, SD = 0.3) compared to the adequate intake group (mean = 3.7 g/dL, SD = 0.4) (p = 0.002). Additionally, lymphocyte counts were significantly lower in the restricted protein group (mean = 950 cells/μL, SD = 180) compared to the adequate group (mean = 1,200 cells/μL, SD = 220) (p = 0.004). A significant correlation was found between lower BMI and higher failure rates (p = 0.001). Conclusion: Protein malnutrition and inadequate preoperative nutritional status are strongly associated with increased AVF failure rates in Stage 5 CKD patients. Ensuring adequate protein intake before surgery is essential for improving AVF outcomes.
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