Abstract: Objective  To investigate the risk factors of  (arteriovenous fistula,AVF) dysfunction in MHD patients and the relationship with aortic arch calcification.  Methods  185 patients with MHD by regular follow-up were retrospectively chosen in the period of January 2015 to January 2020. The enrolled patients were divided into calcified group (138 cases) and non-calcified group (47 cases) according to the presence of aortic arch calcification. The clinical characteristics of the two groups were compared and Logistic regression model was used to explore the independent risk factors of AVF dysfunction. The correlation between aortic arch calcification score and AVF dysfunction was analyzed and ROC curve was drawn to evaluate the predict efficacy on AVF dysfunction of aortic arch calcification score.  Results  The age, pulse pressure difference, corrected calcium, blood phosphorus levels and CRP and AVF function loss rate in calcified group were significantly higher than non-calcified group (P＜0.05). The levels of DBP and iPTH in calcified group were significantly lower than non-calcified group (P＜0.05). Univariate and multivariate analysis results of logistic regression models showed that higher corrected calcium level, higher blood phosphorus level, higher CRP and aortic arch calcification were independent risk factors for AVF dysfunction in patients with MHD (P＜0.05). Spearman test showed that aortic arch calcification score was positively correlated with AVF dysfunction (P＜0.05). ROC curve analysis showed that AUC of aortic arch calcification score in predicting of AVF dysfunction was 0.88 (95% CI: 0.83～0.97), the optimal cut-off value was 2 points, and the sensitivity and specificity were 78.41% and 86.33%, respectively.  Conclusion  The AVF dysfunction in patients with MHD was closely related to aortic arch calcification, abnormal calcium and phosphorus levels, and inflammatory cytokine secretion, and the degree of aortic arch calcification can be used to predict the risk of AVF dysfunction. 

Key words: Hemodialysis, Arteriovenous fistula, Aortic arch, Calcification