Tüysüz Mehmet Erin, Dedemoğlu Mehmet
1 Department of Cardiovascular Surgery, Mersin City Education and Research Hospital, Turkey.
2 Department of Pediatric Cardiovascular Surgery, Mersin City Education and Research Hospital, Turkey.
Vascular. 2019 Jun;27(3):284-290. doi: 10.1177/1708538118814611. Epub 2018 Nov 21.
There is an increased calcium phosphate product level causing the formation of calcification in the arterial wall and thus decreased quality of fistula in patients with chronic renal failure. The purpose of our study is to verify the relationship between arteriovenous fistula re-operation and high calcium phosphate product level.
Seventy-nine consecutive patients with chronic renal failure between April 2016 and February 2018 were included in the study. Patients having calcium phosphate product level ≥50 mg/dl were defined as group 1, whereas those having <50 mg/dl were defined as group 2. Primary outcome of interest was the need for re-operation during the follow-up and to determine the risk factors for re-operation. To determine independent predictors for re-operation, multivariate logistic regression model was used.
The rates of redo and tredo operation were significantly higher in group 1 compared to group 2 ( p = 0.01 and 0.04). In multivariate analysis, phosphate (OR: 1.84, 95% CI: 1.00-3.40, p = 0.05) and triglyceride (OR: 1.01, 95% CI: 1.00-1.02, p = 0.04) levels for redo operation and calcium phosphate product level (OR: 1.11, 95% CI: 1.01-1.22, p = 0.03) for tredo operation were found to be independent predictors.
High calcium phosphate product level leads to increased risk of arteriovenous fistula re-operation by causing arterial stiffness in this patient group. Additionally, these re-operations place additional burden on morbidity and cost efficacy. Thus, we recommend keeping the calcium phosphate product level at the optimal level in these patients to avoid both the risk of arteriovenous fistula re-operation and the other cardiovascular problems.
慢性肾衰竭患者的磷酸钙乘积水平升高会导致动脉壁钙化形成，进而使动静脉内瘘质量下降。本研究的目的是验证动静脉内瘘再次手术与高磷酸钙乘积水平之间的关系。
本研究纳入了2016年4月至2018年2月期间连续的79例慢性肾衰竭患者。磷酸钙乘积水平≥50mg/dl的患者被定义为第1组，而<50mg/dl的患者被定义为第2组。主要关注的结局是随访期间再次手术的必要性，并确定再次手术的危险因素。为了确定再次手术的独立预测因素，使用了多因素逻辑回归模型。
第1组的再次手术和三次手术率显著高于第2组（p = 0.01和0.04）。在多因素分析中，再次手术的磷酸盐（OR：1.84，95%CI：1.00 - 3.40，p = 0.05）和甘油三酯（OR：1.01，95%CI：1.00 - 1.02，p = 0.04）水平以及三次手术的磷酸钙乘积水平（OR：1.11，95%CI：1.01 - 1.22，p = 0.03）被发现是独立预测因素。
高磷酸钙乘积水平通过导致该患者群体的动脉僵硬，增加了动静脉内瘘再次手术的风险。此外，这些再次手术给发病率和成本效益带来了额外负担。因此，我们建议将这些患者的磷酸钙乘积水平保持在最佳水平，以避免动静脉内瘘再次手术的风险和其他心血管问题。
