Abstract: Objective  To investigate the relationship between the degree of vascular calcification (VC) and arteriovenous fistula (AVF) dysfunction in patients with maintenance hemodialysis (MHD).  Methods   A total of 166 patients subjected to standard arteriovenous fistula surgery for the first time in the Department of Nephrology, The Affiliated Hospital of Guilin Medical College from January 2019 to January 2020 were selected. Their general clinical information and laboratory examinations were collected. According to the coronary artery calcification score (CACS) at the time of AVF surgery, the patients were divided into non-calcification group, mild calcification group, moderate calcification group and severe calcification group. The clinical factors relating to CACS and the risk factors for AVF dysfunction were analyzed. The primary patency rate of AVF in 2 years in the patients with and without VC was observed.  Results  A total of 166 MHD patients were enrolled including 92 cases in no calcification group, 33 cases in mild calcification group, 19 cases in moderate calcification group, and 22 cases in severe calcification group. Univariate analysis showed that age (H=4.877, P=0.017), diabetes (c2=9.083, P=0.028), diastolic blood pressure (H=17.037, P=0.001), serum calcium (H=12.260, P=0.007) and intact parathyroid hormone (H=9.698, P=0.021) were statistically different among the four groups (P＜0.05). Multivariate Cox regression showed that venous diameter (HR=0.496, 95% CI:0.317～0.777, P=0.001) was an protective factor for AVF dysfunction. Spearman correlation analysis showed that AVF dysfunction was positively correlated with BMI(r=0.214,P=0.006), albumin(r=0.173,P=0.026), platelet/lymphocyte ratio (PLR r =0.214,P=0.006) and venous diameter(r=0.231,P=0.003). The patency rates were 71.69%, 60.24%, 50% and 40.96% after the surgery for 6 months, 12 months, 18 months and 24 months. Kaplan-Meier survival curve of the primary patency period showed that VC did not affect the patency rate of AVF (log rank test, χ2=2.407, P=0.121).  Conclusions   The degrees of coronary artery calcification had no effect on AVF dysfunction in two years after surgery.

Key words: Hemodialysis, Arteriovenous fistula, Coronary artery calcification