Elevated Phosphorus tied with Primary Failure of Arteriovenous Fistulas: Study

Clinical practice guidelines recommend the arteriovenous fistula (AVF) as the preferred vascular access for hemodialysis. The patency of the arteriovenous access is necessary for effective hemodialysis. However, maintaining the patency of the AVF remains a challenge. Secondary hyperparathyroidism is very common in patients with end-stage chronic kidney disease. The authors determined those independent prognostic factors for the patency of the AVF at the time of its creation.

This is a cross-sectional descriptive study; they included all AVFs performed in our center in the last 2 decades. Demographic variables (age, sex), CKD etiology and associated comorbidity factors were collected. We determine the factors involved in the primary patency of AVFs. The statistical analysis was executed with 25.0 SPSS. The categorical variables are expressed as percentages and were compared using the Chi2 test. The quantitative variables are expressed as mean +/- standard deviation, and the T-student or U Mann Whitney were used to compare them. We establish statistical significance for a value of p <0.05.

Results of the study are as follows:

• They include 622 AVFs performed in 482 patients. 86.8% were autologous. 66.6% were male, with an average age of 65.4 ± 14 years.
• The most frequent CKD etiology were diabetic nephropathy (30.2%), unknown etiology (18%), and glomerular etiology (16.6%). 91.2% had high blood pressure (HBP) and 47.9% diabetes mellitus (DM). 48.7% received antiplatelet therapy and 15.6% anticoagulation prior to the creation of the AVF. 27% presented primary failure.
• The univariate analysis showed statistical significance for qualitative variables including HBP, statin treatment and antiplatelet therapy, and for quantitative variables including fibrinogen, serum phosphorus levels, C-reactive protein, triglycerides, ferritin and age.
• When performing a multivariate analysis using logistic regression, HBP, high serum phosphorus levels and statin treatment are predictors of vascular access thrombosis.

Thus, the researchers concluded that HBP and antiplatelet therapy prior to the creation of the vascular access behave as protective factors for primary failure. Elevated serum phosphorus levels are an independent factor for primary failure of AVFs.

Reference:

Pos-567 mineral bone disease associated with chronic kidney disease. Does it influence in primary permeability after the creation of vascular access for hemodialysis? By P. Castro Fernandez et al published in the Kidney International Reports.

DOI :https://doi.org/10.1016/j.ekir.2021.03.596