Jankovic Aleksandar, Damjanovic Tatjana, Djuric Zivka, Marinkovic Jelena, Schlieper Georg, Djuric Petar, Dragovic Jelena Tosic, Bulatovic Ana, Mitrovic Milos, Popovic Jovan, Floege Jürgen, Dimkovic Nada
Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000, Belgrade, Serbia.
Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
Int Urol Nephrol. 2017 May;49(5):881-887. doi: 10.1007/s11255-017-1515-0. Epub 2017 Jan 25.
Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. The impact of vascular calcification process on AVF survival remains unclear and results of several studies about this issue are controversial. In the light of the new knowledge about the different susceptibility for calcification process in different blood vessels, the aim of our study was to analyze whether the calcification of AVF-blood vessels may have an impact on AVF longevity.
The study included 90 patients, 49 males and 41 females, all of them Caucasians, with a mean age 62 ± 11 years, on regular hemodialysis for more than 1 year with patent primary AVFs. Vascular calcification in AVF-blood vessels or in the anastomotic region was detected using X-ray examination.
Calcification in AVF-blood vessels was found in 62% of patients. Binary logistic regression analysis demonstrated that male gender, presence of diabetes mellitus and longer duration of AVF before calcification determination were associated with calcification of AVF-blood vessels. Using a Cox proportional hazard model adjusted for these standardized predicted values revealed that patients with present AVF-blood vessels calcification had increased risk to develop AVF failure with a hazard rate of 3.42 (95% confidence interval 1.00-11.67; P = 0.049).
Calcifications of AVF-blood vessels are found frequently among dialysis patients and may jeopardize the survival of native AVF. We suggested the local X-ray as simple and valid method for detection of patients that are at risk for AVFs failure which should be monitored more closely.
动静脉内瘘（AVF）是血液透析首选的血管通路。血管钙化过程对AVF存活的影响尚不清楚，关于此问题的多项研究结果存在争议。鉴于对不同血管钙化过程易感性的新知识，我们研究的目的是分析AVF血管钙化是否会对AVF的使用寿命产生影响。
该研究纳入了90例患者，其中男性49例，女性41例，均为白种人，平均年龄62±11岁，接受规律血液透析超过1年且原发性AVF通畅。使用X线检查检测AVF血管或吻合区域的血管钙化情况。
62%的患者存在AVF血管钙化。二元逻辑回归分析表明，男性、患有糖尿病以及在确定钙化前AVF使用时间较长与AVF血管钙化有关。使用针对这些标准化预测值进行调整的Cox比例风险模型显示，存在AVF血管钙化的患者发生AVF失功的风险增加，风险比为3.42（95%置信区间1.00 - 11.67；P = 0.049）。
透析患者中AVF血管钙化很常见，可能会危及自体AVF的存活。我们建议将局部X线检查作为检测有AVF失功风险患者的简单有效方法，应对这些患者进行更密切的监测。
