C-reactive protein as a prognostic risk factor for loss of arteriovenous fistula patency in hemodialyzed patients

Inflammation is a cardiovascular risk factor in hemodialysis patients, but its influence on vascular access patency is still debatable. Our prospective study investigated this issue. A total of 258 patients receiving an arteriovenous fistula (AVF) between 2006 and 2016 at the Municipal Hospital Arad...

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Bibliographic Details
Published in:	Journal of vascular surgery Vol. 70; no. 1; pp. 208 - 215
Main Authors:	Stirbu, Oana, Gadalean, Florica, Pitea, Iancu Viorel, Ciobanu, Gheorghe, Schiller, Adalbert, Grosu, Iulia, Nes, Alin, Bratescu, Roxana, Olariu, Nicu, Timar, Bogdan, Tandrau, Mircea Calin
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-07-2019
Subjects:	Adult Aged Aged, 80 and over Arteriovenous fistula Arteriovenous Shunt, Surgical - adverse effects Biomarkers - blood C-reactive protein C-Reactive Protein - metabolism Female Graft Occlusion, Vascular - blood Graft Occlusion, Vascular - etiology Graft Occlusion, Vascular - physiopathology Graft Occlusion, Vascular - surgery Humans Inflammation Mediators - blood Loss of AVF patency Male Middle Aged Predictive Value of Tests Prospective Studies Renal Dialysis Reoperation Risk Risk Assessment Risk Factors Romania Time Factors Treatment Outcome Vascular Patency Romania Risk Arteriovenous fistula C-reactive protein Loss of AVF patency
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Summary:	Inflammation is a cardiovascular risk factor in hemodialysis patients, but its influence on vascular access patency is still debatable. Our prospective study investigated this issue. A total of 258 patients receiving an arteriovenous fistula (AVF) between 2006 and 2016 at the Municipal Hospital Arad were included. Demographic, clinical, and laboratory characteristics were collected at the time of creation of the AVF. The primary study end point was AVF patency loss, defined as an event occurring at least 2 months after AVF formation and requiring surgical revision or replacement of the fistula. The patients were followed up for a median time of 26 months. In our group, the mean age was 59.7 ± 13.2 years (median, 62 years), and 60.1% were male. During follow-up, 134 patients (51.9%) maintained AVF patency, whereas 124 (48.1%) lost AVF patency within a mean time of 23.3 ± 28.1 months (median, 10.5 months). We found that age (hazard ratio [HR], 1.015; P = .035) and C-reactive protein (CRP) level (HR, 1.17; P < .0001) were associated with a higher risk of loss of AVF patency. The protective factors for AVF patency were autosomal dominant polycystic kidney disease (HR, 0.336; P = .009), pre-emptive AVF (HR, 0.648; P = .031), and higher level of triglycerides (HR, 0.998; P = .035). In the multivariate adjusted Cox model, CRP level remained an independent predictor for loss of AVF patency (HR, 1.17; 95% confidence interval, 1.1-1.3; P < .0001). In our study, CRP level was an independent predictor of AVF patency loss, whereas better AVF survival was independently associated with autosomal dominant polycystic kidney disease and pre-emptive AVF. As a simple noninvasive marker of chronic inflammation, CRP level may be a useful tool to predict AVF outcomes. Further research is needed to assess the protective effects of inflammation reduction on AVF survival.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23
ISSN:	0741-5214 1097-6809
DOI:	10.1016/j.jvs.2018.10.100