Gołębiowski Tomasz, Kusztal Mariusz, Letachowicz Krzysztof, Augustyniak-Bartosik Hanna, Szymczak Maciej, Krajewska Magdalena, Marcinkowski Wojciech, Weyde Wacław, Klinger Marian
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wroclaw, Poland.
Ann Vasc Surg. 2017 Nov;45:179-185. doi: 10.1016/j.avsg.2017.06.051. Epub 2017 Jun 23.
The aim of this study was to evaluate the association of hemodynamic parameters related to hemodialysis and antropometric parameters of patients with changes in the venous part of the arteriovenous fistula (AVF) at points of needling.
Two hundred forty-two hemodialysis (HD) patients (60.3% men), with median age 65 (interquartile range [IQR] 56-75) years, on HD treatment for a median of 49 (IQR 20-88) months with functioning fistula were recruited for the study. The history of vascular access, comorbidity, antropometric (body mass index, body surface area, and body composition), and dialysis-related parameters were analyzed. The cross-sectional area of upper extremity vessels were measured using ultrasound and included 2 points: A (arterial point for blood aspiration) and V (venous point for returning the blood after purification). The difference between A and V (A-V) was calculated.
The median cross-sectional area of A was larger than V (1.04 [IQR 0.58-1.7] vs. 0.74 cm [IQR: 0.41-1.39], P <0.0001). The median difference between A and V (A-V) was 0.17 cm and positively correlated with mean blood flow (Qb), effective Kt/V, and time of AVF use. Other analyzed factors had no influence on A-V. In the multivariate analysis, the independent factor increasing the difference (A-V) was mean blood flow measured during HD sessions.
The needling and utilization of AVF for hemodialysis may affect vein anatomy, namely causing dilatation at the arterial point and narrowing at venous point of AVF. We suggest that blood pump velocity of the dialysis machine may have an impact on these changes, but practical importance of these findings has to be elucidated. The significance of (A-V) factor in the prognosis of fistula complications should be further studied and confirmed in the prospective trials.
本研究旨在评估与血液透析相关的血流动力学参数以及患者人体测量学参数与动静脉内瘘（AVF）穿刺部位静脉部分变化之间的关联。
招募了242例接受血液透析（HD）治疗的患者（男性占60.3%），中位年龄65岁（四分位间距[IQR]为56 - 75岁），中位血液透析治疗时间为49个月（IQR为20 - 88个月），且内瘘功能良好。分析血管通路史、合并症、人体测量学指标（体重指数、体表面积和身体成分）以及与透析相关的参数。使用超声测量上肢血管的横截面积，包括2个点：A点（采血动脉点）和V点（血液净化后回血静脉点）。计算A点与V点之间的差值（A - V）。
A点的中位横截面积大于V点（1.04[IQR 0.58 - 1.7] vs. 0.74 cm[IQR: 0.41 - 1.39]，P <0.0001）。A点与V点之间的中位差值（A - V）为0.17 cm，且与平均血流量（Qb）、有效Kt/V以及AVF使用时间呈正相关。其他分析因素对A - V无影响。在多变量分析中，增加差值（A - V）的独立因素是血液透析过程中测量的平均血流量。
血液透析时AVF的穿刺和使用可能会影响静脉解剖结构变化，即导致AVF动脉点扩张和静脉点狭窄。我们认为透析机的血泵速度可能对这些变化有影响，但这些发现的实际重要性有待阐明。（A - V）因素在瘘管并发症预后中的意义应在前瞻性试验中进一步研究和证实。
