Abstract: 【Abstract】Objective To investigate the correlation between G-395A polymorphism in klotho gene and autogenous arteriovenous fistula (AVF) dysfunction in maintenance hemodialysis (MHD) patients. Methods This prospective study included 198 MHD patients undergoing AVF surgery at Jiangsu Province Subei People's Hospital in the period from January 2015 to January 2018. The singlEnucleotide polymorphism at the G-395A in Klotho gene was identified by first generation sequencing. Serum klotho and FGF23 levels were measured by ELISA. Clinical and biochemical data were collected. Cox regression model was used to analyze the relevant factors affecting the life span of AVF. Results These MHD patients were followed up for 2 years, in which 5 lost the follow-up, and 3 died. The survival rates of AVF after one and two years were 88.9% and 77.8%, respectively. According to the presence or absence of A allele, the patients were divided into A allele carriers (GA genotype or AA genotype) and non-A carriers (GG genotype). The patency rate was lower in A allele carriers than in non-A carriers (χ2=9.062, P=0.003). Multivariate Cox proportional hazards model showed that genotype (HR=2.664, 95% CI: 1.594-～4.452, P<0.001), history of catheterization (HR=2.299, 95% CI:1.048～5.045, P=0.038) and FGF23 level (HR=1.002, 95% CI: 1.000～1.003, P=0.009) were the factors influencing long-term patency of AVF. Conclusion The G-395A polymorphism in klotho gene may relate to the long-term patency of autogenous AVF in MHD patients, and A allele may be an independent risk factor for AVF failure.

Key words: Klotho gene, Fibroblast growth factor 23, Klotho protein, Maintenance hemodialysis, Autologous arteriovenous fistula