Chinese Journal of Blood Purification

Chinese Journal of Blood Purification ›› 2022, Vol. 21 ›› Issue (07): 530-535.doi: 10.3969/j.issn.1671-4091.2022.07.015

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AThe influencing factors of arteriovenous fistula dysfunction in non-diabetic maintenance hemodialysis patients

  

  1. Department of Nephrology, the Second Hospital of Shanxi Medical University, Taiyuan 030001, China; 2Blood Purification Quality
    Control Center of Medical Quality Control and Management Center, Health Commission of Shanxi Provence,
    Taiyuan 030001, China
  • Received:2022-03-07 Revised:2022-05-05 Online:2022-07-12 Published:2022-07-12

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Abstract: Objective To investigate the failure of arteriovenous fistula (AVF) in non-diabetic hemodialysis patients and to explore the related factors affecting the AVF function. Methods Ninety-two non-diabetic
patients who received maintenance hemodialysis (MHD) in the Hemodialysis Center of The Second Hospital
of Shanxi Medical University from January to June 2021 and had complete clinical data were enrolled in this
study. The patients were divided into AVF normal group and AVF failure group according to the diagnosis criteria of AVF failure. The differences in clinical data were retrospectively analyzed between the two groups.
Multivariate Cox risk regression model was used to analyze the influencing factors Results Diastolic blood
pressure (t=-5.143, P< 0.001), cephalic vein diameter (Z=-3.847, P< 0.001), radial artery diameter (Z=-3.734,
P<0.001), and serum albumin (t=-3.741, P=0.001) were lower, while serum phosphorus (t=2.076, P=0.041),
calcium-phosphorus product (t=2.444, P=0.016), C-reactive protein (Z=2.477, P=0.013) and the incidence of
malnutrition-inflammation-atherosclerosis syndrome (MIAS) (χ2=4.943, P=0.026) were higher in AVF failure
group as compared those in AVF normal group. Multivariate Cox regression showed that higher diastolic
blood pressure (HR=0.957, 95% CI：0.917～0.998, P=0.039), higher serum albumin (HR=0.831, 95% CI：
0.767～0.899, P<0.001), and larger radial artery diameter (HR=0.079, 95% CI 0.019～0.338, P=0.001) were
the protective factors for functional AVF, while the complication of MIAS (HR=4.059, 95% CI 1.128～
14.614, P=0.032) was a risk factor for AVF failure. Kaplan-Meier survival curve showed that the AVF lifetime
in patients with hypoalbuminemia was significantly shorter than that in patients without hypoalbuminemia
(log-rank test: c2=27.776, P<0.001). Conclusion Higher diastolic blood pressure is a protective factor for
functional AVF, while hypoalbuminemia and the complication of MIAS are risk factors for AVF failure in nondiabetic MHD patients.

Key words: Maintenance hemodialysis, Arteriovenous fistula, Influencing factors, Fistula failure, Survival analysis

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