Risk Factors for Primary Arteriovenous Fistula Dysfunction in Hemodialysis Patients: A Retrospective Survival Analysis in Multiple Medical Centers

摘要

Background: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD). However, primary AVF dysfunction represents a major barrier to the long-term success of HD therapy. This study aims to analyze the variables that influence the incidence of first AVF failure in HD patients. Methods: From January 2012 to October 2016, a total of 100 HD subjects from 43 medical centers were enrolled for a retrospective survival analysis of AVF dysfunction. To diminish the potential influence of surgeon experiences, the same operation group in Second Xiangya Hospital performed all studied AVF placements. This study focuses on a Chinese population of idiopathic glomerular disease to avoid the secondary influence of other systemic diseases, including diabetes, hypertension, and autoimmune disorder. AVF dysfunction was defined as lower blood flow during dialysis (<= 200 mL/min) or insufficiency of HD treatment caused by reduced blood flow. Results: Among all enrolled subjects, the incidence of AVF dysfunction due to impatency was 27% (n = 27) with a cumulative survival of 84.0, 73.1, and 71.6% in 6, 12, and 24 months of post-placement. AVF survival -analysis revealed a higher incidence of AVF failure in females (p= 0.025) and elderly (p = 0.031) patients. Importantly, AVF dysfunction markedly increased in subjects with higher levels of platelets (PLTs; p = 0.024), severe anemia (p = 0.014), and extended temporary catheter retention (p = 0.020). Further multivariate Cox regression analysis confirmed these variables as independent risk factors for first AVF dysfunction. Meanwhile, no significant difference could be observed according to the levels of body mass index, serum albumin, serum calcium, serum phosphorus, prothrombin time, and activated partial thromboplastin time. Lastly, anti-coagulant treatments seemed to barely influence the outcomes of AVF survival in this study. Conclusion: These findings suggest that primary AVF dysfunction in HD patients is associated with gender, ageing, PLT counting number, hemoglobin level, and retention time of temporary catheter.