Kaller Réka, Russu Eliza, Arbănași Emil Marian, Mureșan Adrian Vasile, Jakab Márk, Ciucanu Claudiu Constantin, Arbănași Eliza Mihaela, Suciu Bogdan Andrei, Hosu Ioan, Demian Liliana, Horváth Emőke
Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania.
Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania.
J Clin Med. 2023 Jun 30;12(13):4419. doi: 10.3390/jcm12134419.
Arteriovenous fistula dysfunction is a widely disputed subject in the scientific literature on end-stage kidney disease (ESKD). The main cause of mortality and morbidity in these patients is the non-maturation or dysfunction of the arteriovenous fistula. Despite the many complications, the native arteriovenous fistula remains the gold standard in the treatment of these patients requiring renal replacement. This study aims to discuss the predictive role of some systemic inflammatory biomarkers (NLR, PLR, SII, IL-6), intimal hyperplasia, and neoangiogenesis (characterized by intimal-media CD31-positive relative surface) in arteriovenous fistula maturation failure.
The present study was designed as an observational, analytical, and prospective study which included patients diagnosed with ESKD with indications of radio-cephalic arteriovenous fistula (RCAVF). Demographic data, comorbidities, preoperative laboratory data and histological/digital morphometry analysis results were processed. The patients included were divided into two groups based on their AVF maturation status at 8 weeks: "Maturation" (Group 1) and "Failed Maturation" (Group 2).
There was no difference in the demographic data. In terms of comorbidities, the second group had a greater incidence of heart failure ( = 0.03), diabetes ( = 0.04), peripheral artery disease ( = 0.002), and obesity ( = 0.01). Additionally, regarding the laboratory findings, these patients had higher levels of serum uric acid ( = 0.0005), phosphates ( < 0.0001), and creatinine ( = 0.02), as well as lower levels of total calcium ( = 0.0002), monocytes ( = 0.008), and lymphocytes ( < 0.0001). Moreover, all inflammatory markers ( = 0.001; < 0.0001; = 0.006, and = 0.03) and Ca-P product ( < 0.0001) had higher baseline values in Group 2. Upon immunohistochemical analysis, regarding the density of neoformed vessels, there was a higher incidence of CD31-positive surfaces ( = 0.006) and CD31-positive relative surfaces ( = 0.001); the NLR (r = 0.323; = 0.03), PLR (r = 0.381; = 0.04), SII (r = 0.376; = 0.03), and IL-6 (r = 0.611; < 0.001) are all significantly correlated with vascular density, as evidenced by CD31.
Heart failure, peripheral artery disease, obesity, and diabetes, as well as the systemic inflammatory markers (NLR, PLR, SII, IL-6), intimal hyperplasia, and CD31-positive relative surfaces are predictors of arteriovenous fistula maturation failures.
动静脉内瘘功能障碍是终末期肾病（ESKD）科学文献中一个备受争议的主题。这些患者死亡和发病的主要原因是动静脉内瘘未成熟或功能障碍。尽管存在许多并发症，但自体动静脉内瘘仍是这些需要肾脏替代治疗患者的金标准。本研究旨在探讨一些全身炎症生物标志物（中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、全身免疫炎症指数（SII）、白细胞介素 - 6（IL - 6））、内膜增生和新生血管形成（以内膜 - 中膜CD31阳性相对面积为特征）在动静脉内瘘成熟失败中的预测作用。
本研究设计为一项观察性、分析性和前瞻性研究，纳入诊断为ESKD且有桡动脉 - 头静脉内瘘（RCAVF）指征的患者。处理人口统计学数据、合并症、术前实验室数据以及组织学/数字形态学分析结果。根据患者8周时的动静脉内瘘成熟状态将纳入的患者分为两组：“成熟组”（第1组）和“成熟失败组”（第2组）。
人口统计学数据无差异。在合并症方面，第二组心力衰竭（P = 0.03）、糖尿病（P = 0.04）、外周动脉疾病（P = 0.002）和肥胖（P = 0.01）的发生率更高。此外，关于实验室检查结果，这些患者血清尿酸（P = 0.0005）、磷酸盐（P < 0.0001）和肌酐（P = 0.02）水平较高，而总钙（P = 0.0002）、单核细胞（P = 0.008）和淋巴细胞（P < 0.0001）水平较低。此外，所有炎症标志物（P = 0.001；P < 0.0001；P = 0.006，和P = 0.03）以及钙 - 磷乘积（P < 0.0001）在第2组中的基线值更高。免疫组织化学分析显示，关于新生血管密度，CD31阳性面积（P = 0.006）和CD31阳性相对面积（P = 0.001）的发生率更高；NLR（r = 0.323；P = 0.03）、PLR（r = 0.381；P = 0.04）、SII（r = 0.376；P = 0.03）和IL - 6（r = 0.611；P < 0.001）均与CD31所证实的血管密度显著相关。
心力衰竭、外周动脉疾病、肥胖和糖尿病，以及全身炎症标志物（NLR、PLR、SII、IL - 6）、内膜增生和CD31阳性相对面积是动静脉内瘘成熟失败的预测因素。
