Department of Internal Medicine and Clinical Nutrition, Institution of Medicine, University of Gothenburg, Sweden.
Skaraborg Hospital, Skövde, Sweden.
Clin Hemorheol Microcirc. 2019;71(1):53-57. doi: 10.3233/CH-180381.
A native AV-fistula (AVF) for access in hemodialysis (HD) is preferable. Stenosis, a major hurdle, is associated with older age and diabetes mellitus.
This case-control study aimed to clarify if any medical and/or laboratory factors, that can be altered, could be associated to AVF stenosis.
33 patients with a patent AVF without need of intervention during a two year period (Controls) were matched by diagnosis and age with 33 patients (Cases), that had at least one radiological invasive examination/intervention due to suspected AVF malfunction (case-control mode 2:1).
Cases had higher weekly doses of Erythropoietin-Stimulating Agent (ESA) than Controls both before intervention (mean 8312±7119 U/w versus 4348±3790, p = 0.005) and after the intervention (7656±6795, versus 4477±3895, p = 0.018). Before intervention serum phosphate was higher in Cases while there was no significant difference in blood hemoglobin, weekly standard Kt/V, parathyroid hormone, calcium, albumin, C-reactive protein, smoking habits, BMI or other medication.
Higher doses of ESA were administered in patients with AVF stenosis. Since ESA may cause local hypertrophic effects on the vascular endothelium, we should prescribe lower doses of ESA in patients at risk. Further studies should clarify such connection.
用于血液透析（HD）的原生动静脉瘘（AVF）是首选。狭窄是一个主要障碍，与年龄较大和糖尿病有关。
本病例对照研究旨在阐明是否有任何可以改变的医疗和/或实验室因素与 AVF 狭窄有关。
33 名在两年期间无需干预即可维持通畅的 AVF 患者（对照组），通过诊断和年龄与 33 名因怀疑 AVF 功能障碍而至少进行过一次放射学侵入性检查/干预的患者（病例组）相匹配（病例对照模式 2:1）。
病例组在干预前（平均 8312±7119 U/w 比 4348±3790，p = 0.005）和干预后（7656±6795，比 4477±3895，p = 0.018）的每周红细胞生成素刺激剂（ESA）剂量均高于对照组。在干预前，病例组的血清磷酸盐较高，而血红蛋白、每周标准 Kt/V、甲状旁腺激素、钙、白蛋白、C 反应蛋白、吸烟习惯、BMI 或其他药物无显著差异。
AVF 狭窄患者接受了更高剂量的 ESA。由于 ESA 可能对血管内皮产生局部肥大作用，我们应该在有风险的患者中开具较低剂量的 ESA。需要进一步的研究来阐明这种联系。
