Ozdemir F N, Akcay A, Bilgic A, Akgul A, Arat Z, Haberal M
Department of Nephrology, Baskent University Faculty of Medicine, Ankara, Turkey.
Transplant Proc. 2005 Sep;37(7):2918-21. doi: 10.1016/j.transproceed.2005.07.011.
Arteriovenous fistulae (AVF) failure is the most common cause of morbidity and hospitalization in hemodialysis (HD) patients. The purpose of this study was to determine the effects of smoking and blood eosinophil count on the development of AVF thrombosis in HD patients. This cross-sectional study included 141 patients (M/F 80/61; age 43.4 +/- 11.6 years, HD duration 7.7 +/- 4.4 years). The following were analyzed as possible risk factors for AVF failure for all patients: demographic features, dialysis time, smoking, medications, body mass index, comorbid diseases, and various laboratory parameters (whole blood count and serum levels of albumin, calcium, phosphorus, uric acid, C-reactive protein, ferritin, and parathyroid hormone). AVF thrombosis was detected in 60 patients; in contrast, 81 patients had no thrombosis. Distributions of age, gender, and HD duration were similar between both groups. Univariate analysis showed that snuffbox AVF location (P < .0001), higher blood eosinophil count (P < .0001), smoking (P < .01), and higher hematocrit level (P < .05) were all associated with AVF thrombosis. According to multivariate analysis by logistic regression models, eosinophil count (RR = 1.005, P < .05) and snuffbox location (RR = 5.970, P < .05) were predictors of AVF thrombosis. When AVF location was excluded from the analysis, smoking (RR = 4.140, P < .01) and high blood eosinophil count (RR = 1.006, P < .005) were independent risk factors for thrombosis. Our study indicates that smoking and high blood eosinophil count may contribute to the development of AVF thrombosis.
动静脉内瘘（AVF）失功是血液透析（HD）患者发病和住院的最常见原因。本研究的目的是确定吸烟和血液嗜酸性粒细胞计数对HD患者AVF血栓形成的影响。这项横断面研究纳入了141例患者（男/女80/61；年龄43.4±11.6岁，HD病程7.7±4.4年）。分析了以下所有患者AVF失功的可能危险因素：人口统计学特征、透析时间、吸烟、用药情况、体重指数、合并疾病以及各种实验室参数（全血细胞计数和血清白蛋白、钙、磷、尿酸、C反应蛋白、铁蛋白及甲状旁腺激素水平）。60例患者检测到AVF血栓形成；相比之下，81例患者未发生血栓形成。两组间年龄、性别和HD病程分布相似。单因素分析显示，鼻烟窝AVF位置（P<0.0001）、较高的血液嗜酸性粒细胞计数（P<0.0001）、吸烟（P<0.01）和较高的血细胞比容水平（P<0.05）均与AVF血栓形成相关。根据逻辑回归模型进行的多因素分析，嗜酸性粒细胞计数（RR=1.005，P<0.05）和鼻烟窝位置（RR=5.970，P<0.05）是AVF血栓形成的预测因素。当分析中排除AVF位置因素时，吸烟（RR=4.140，P<0.01）和高血液嗜酸性粒细胞计数（RR=1.006，P<0.005）是血栓形成的独立危险因素。我们的研究表明，吸烟和高血液嗜酸性粒细胞计数可能促使AVF血栓形成。
