Serati A R, Roozbeh J, Sagheb M M
Division of Cardiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
J Vasc Access. 2007 Apr-Jun;8(2):109-14.
Arteriovenous fistula thrombosis (AVFT) is still a common cause of morbidity in patients undergoing regular hemodialysis (HD). Many factors have been found to induce AVFT. Some of those factors are local and others are systemic ones. In this study, we evaluated some local and systemic factors simultaneously, to predict the most potent risk factor for AVFT in HD patients.
One hundred and eighteen patients aged 20-80 yrs with end-stage renal disease (ESRD) were evaluated prospectively for a period of 14 months. First, anticardiolipin antibodies (ACLA), TG, cholesterol, low density lipoprotein (LDL) and high density lipoprotein (HDL) were analyzed by conventional methods. Other basic data were accessed from patients medical records. All fistulas were evaluated clinically as patent at the start of this study. Patients were followed-up for any evidence of AVFT within 14 months. Finally, all factors (diabetes, hypertension, presence of ACLA, ultrafiltration >or=3 L, age, gender, weight, hypotension during dialysis, fistula site, epoetin alpha usage, TG, HDL, LDL and total cholesterol) were analyzed in a stepwise regression analysis.
Eighteen episodes of AVFT documented with Doppler sonography occurred in 17 patients (15.3%). Regression analysis showed only LDL values were the AVFT predictor in our patients (p=0.002, beta-coefficient=0.3). Kaplan-Meier analysis showed a significantly lower AVF patency time in patients with LDL >130 mg/dl than those with LDL <130 mg/dl (log rank=0.0014).
LDL value is a major prognostic factor for AVFT in HD patients and lowering it to <130 mg/dl could improve fistula patency.
动静脉内瘘血栓形成（AVFT）仍是接受定期血液透析（HD）患者发病的常见原因。已发现许多因素可诱发AVFT。其中一些因素是局部的，另一些是全身性的。在本研究中，我们同时评估了一些局部和全身性因素，以预测HD患者发生AVFT的最主要危险因素。
对118例年龄在20 - 80岁的终末期肾病（ESRD）患者进行了为期14个月的前瞻性评估。首先，采用传统方法分析抗心磷脂抗体（ACLA）、甘油三酯（TG）、胆固醇、低密度脂蛋白（LDL）和高密度脂蛋白（HDL）。从患者病历中获取其他基础数据。在本研究开始时，所有内瘘经临床评估均为通畅。对患者随访14个月，观察有无AVFT迹象。最后，对所有因素（糖尿病、高血压、ACLA的存在、超滤量≥3L、年龄、性别、体重、透析期间低血压、内瘘部位、促红细胞生成素α的使用、TG、HDL、LDL和总胆固醇）进行逐步回归分析。
17例患者（15.3%）经多普勒超声检查记录到18次AVFT发作。回归分析显示，仅LDL值是我们患者发生AVFT的预测指标（p = 0.002，β系数 = 0.3）。Kaplan-Meier分析显示，LDL>130mg/dl的患者动静脉内瘘通畅时间明显低于LDL<130mg/dl的患者（对数秩检验 = 0.0014）。
LDL值是HD患者发生AVFT的主要预后因素，将其降至<130mg/dl可改善内瘘通畅情况。
