[Clinical features and fistula acoustic characteristics in maintenance hemodialysis patients with versus without diabetes mellitus].

Objective

To compare the clinical features and acoustic characteristics of native arteriovenous fistulas (AVF) between maintenance hemodialysis (MHD) patients with and without diabetes mellitus.

Methods

In this cross-sectional study, MHD patients using AVF from the Blood Purification Center of Northern Jiangsu People's Hospital Affiliated to Yangzhou University between March and August 2024 were enrolled. AVF morphology and hemodynamics were assessed via ultrasonography, while concomitant audio recordings were obtained for acoustic analysis. Participants were stratified by diabetes status, and differences in clinical, ultrasonographic, and acoustic features were analyzed.

Results

A total of 192 patients (119 males and 73 females) aged (58.6±12.7) years were enrolled. Those with diabetes had greater height, weight, and body surface area but shorter dialysis duration and lower albumin, prealbumin, and hemoglobin levels (all P<0.05). Ultrasonography revealed smaller vascular diameters at the anastomosis, within 3 cm proximally, at the puncture site, and in the radial artery 2 cm from the brachial artery bifurcation in the diabetic group (all P<0.05). Resistive indices (at the anastomosis and within 3 cm proximally) and puncture depth were higher in diabetic patients (all P<0.05). The multiple linear regression analysis indicated that diabetes mellitus (β=0.102, 95%CI: 0.051-0.153, P<0.001) was associated with an increased anastomosis resistive index. The diabetic group demonstrated a significantly higher zero-crossing rate [0.011 (0.009, 0.012) vs 0.008 (0.007, 0.011), P<0.001], but lower acoustic wave amplitude [-13.2 (-20.6, -10.6) dB vs -11.5 (-14.3, -10.3) dB, P=0.049], mean mel-frequency cepstral coefficients (MFCC) [7.6 (0.4, 10.2) vs 10.4 (7.2, 12.2), P<0.001], and mean extended Geneva minimalistic acoustic parameter set (eGEmaps) values [112 (109, 114) vs 113 (112, 115), P=0.011] compared to the non-diabetic group.

Conclusions

MHD patients with diabetes exhibit distinct AVF profiles characterized by smaller vascular diameters, greater puncture depth and resistance indices, higher acoustic zero-crossing rates, and lower mean MFCC and eGEMAPS values compared to non-diabetic patients.