The clinicopathological determinants of native arteriovenous fistula failure in patients on maintenance hemodialysis

• Published in: Advances in clinical and experimental medicine : official organ Wroclaw Medical University Vol. 22; no. 4; pp. 495 - 500
• Main Authors: Hruby, Zbigniew, Stanek-Piotrowska, Maria, Turek, Jakub, Witkiewicz, Wojciech, Jonkisz, Anna, Konieczny, Andrzej, Kosiński, Mariusz, Dobosz, Tadeusz
• Format: Journal Article
• Language: English
• Published: Poland 01.07.2013
• Subjects: Adult; Aged; Aged, 80 and over; Arteriovenous Shunt, Surgical - adverse effects; Arteriovenous Shunt, Surgical - mortality; Female; Hemodynamics; Humans; Inflammation Mediators - analysis; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - therapy; Male; Middle Aged; Proportional Hazards Models; Proto-Oncogene Proteins c-sis - genetics; Renal Dialysis - adverse effects; Renal Dialysis - mortality; Risk Factors; RNA, Messenger - analysis; Time Factors; Transforming Growth Factor beta - genetics; Treatment Failure; Ultrasonography, Doppler, Duplex; Upper Extremity - blood supply; Veins - chemistry; Veins - diagnostic imaging; Veins - physiopathology
• ISSN: 1899-5276

Progressive narrowing of the venous part of dialysis fistulae is caused by hemodynamic and inflammatory factors. The pathogenic and clinical determinants of deterioration of the functioning of arteriovenous fistulae in chronically hemodialyzed patients were evaluated. The hemodynamic parameters and the activity of inflammatory growth factors in the vessel wall of newly implanted fistulae were assessed and correlated with the clinical course of 34 hemodialyzed patients. Measurements taken at the time of implanting the fistulae included blood flow in the venous part of the anastomosis and its widest diameter by ultrasound Power Doppler, a histopathologic examination of fistula wall samples and measurements of mRNA expression for growth factors PDGFβ1 and TGFβ in the fistula wall. The results were correlated with clinical data from 36 months' observation: duration of fistula maturation, adequacy of dialysis treatment (eKt/V), the patient's survival, morbidity linked with vascular access problems and general cardiovascular morbidity. The mean duration of fistula maturation was 44.9 days (N = 43, SD = 38.6), whereas the average duration of fistula usage as dialysis access was 795.9 ± 480.6 days. Fistula blood flow at the time of implantation, averaged 1782.2 ± 1735.3 ml/min. The mean number of hospitalization days due to vascular access morbidity was 9.9 ± 15.6 days and it correlated positively with the fistula blood flow (R = 0.596, P = 0.004). There was a negative correlation between the expression of PDGFβ1 mRNA and fistula blood flow (R = -0.673, P = 0.011), as well as between TGFβ expression and patient survival (R = -0.722, P = 0.002). Inflammatory activity of the vessel wall growth factors PDGFβ1 and TGFβ implies impairment of fistula function and the patient's cardiovascular morbidity.