Gelsolin as a predictor of arteriovenous fistula maturation.

BACKGROUND

Gelsolin is a key regulator of actin filament metabolism and plays a role in tissue remodeling. We evaluated plasma gelsolin (pGSN) in predicting arteriovenous fistula (AVF) maturation.

METHODS

Only patients with newly created radiocephalic AVF were included. pGSN and plasma F-actin levels were measured preoperatively. Maturation was defined as an access (cephalic) vein diameter > 5 mm and a fistula blood flow rate > 500 mL/min in ultrasound, 8 weeks after operation.

RESULTS

A total of 68 patients were analyzed with a mean age of 62.6 ± 11.1 years. AVF maturation was identified in 39 patients (57.3%). Mean pGSN level was 4726 (3836-6483) ng/mL in patients with mature AVF and 3237 (2895-4382) ng/mL in patients with immature AVF. pGSN levels were significantly higher (p < 0.001) in the mature AVF group. F-actin levels were not significantly different between two groups. pGSN levels positively correlated with fistula blood flows (r = 0.326, p = 0.007). Multivariate logistic regression analysis revealed that pGSN (p = 0.003) was determined to be an independent risk factor in predicting AVF maturation. Preoperative pGSN levels were significantly predictive of AVF maturation in the ROC analysis. Sensitivity and specificity of pGSN were 82.1% and 58.6%, respectively, with a cut-off value of > 3716 ng/mL and an area under the ROC curve of 0.75 (95% CI: 0.64-0.87, p < 0.001).

CONCLUSION

Current results demonstrated that patients with mature AVFs had significantly higher preoperative pGSN levels compared to those with immature AVFs. Outcomes suggest that pGSN could serve as a predictive biomarker for AVF maturation.