Dietary Protein and Fluid Management in CKD Patients Undergoing Arteriovenous Fistula (AVF) Surgery: Investigating the Role of Nutrition on Reducing Fistula Failure

Abstract

Background: Chronic Kidney Disease (CKD) patients undergoing arteriovenous fistula (AVF) surgery often face complications related to AVF failure, which can be influenced by nutritional factors like dietary protein intake and fluid management. Objective: To investigate the role of dietary protein, fluid management, serum albumin, and creatinine clearance in reducing AVF failure and improving surgical outcomes in CKD patients. Method: A prospective cohort study was conducted with 214 CKD patients undergoing AVF surgery at Rajshahi Diabetic Association General Hospital from January 2022 to December 2023. Patients were divided into two groups based on their dietary protein intake and fluid management practices. Data on serum albumin and creatinine clearance levels were collected at baseline and during follow-up visits. Statistical analysis, including regression models, was used to assess the correlation between nutritional status and AVF success. Results: Of the 214 patients, 89% had successful AVF maturation, while 11% experienced AVF failure. Serum albumin levels were significantly higher in the successful group (4.1 ± 0.5 g/dL) compared to the failure group (2.8 ± 0.6 g/dL) (p < 0.05). Patients with creatinine clearance > 30 mL/min had a 65% higher likelihood of AVF maturation compared to those with lower clearance. Additionally, patients with optimal dietary protein intake (≥1.2 g/kg/day) had a 25% higher success rate of AVF maturation compared to those with inadequate intake. Fluid management interventions reduced fluid overload by 15%, which was associated with a 20% improvement in fistula maturation success. Conclusions: Adequate dietary protein, fluid management, and optimized serum albumin and creatinine clearance are crucial for improving AVF outcomes in CKD patients. These factors should be integrated into clinical protocols to reduce AVF failure.