Hypoproteinemia as a prognostic risk factor for arteriovenous fistula failure

Abstract

Introduction: Any vascular access is of limited duration with many factors which influence survival in patients on chronic hemodialysis (HD). Hypoproteinemia as a marker of chronic illness is common among chronic HD patients. Our aim was to analyze the survival of the primary arteriovenous fistula (AVFs) and the risk factors which influence their patency and to test the hypothesis that patients with normal values of serum proteins have lower risk of AVF failure compared to patients with hypoproteinemia.Methods: Seven hundred thirty-four consecutive patients were included who underwent creation of an AVF. The patients were prospectively followed-up for 2 years. Only patients with AVF function after a month from its creation were analyzed. The patients were divided into two subgroups, with normal and low serum protein levels (<65 g/L).Findings: At follow-up 497 (67.7%) AVFs were still functional while 237 (32.3%) AVFs failed due to thrombosis or stenosis. Serum proteins and AVFs created on the forearm were positive predictors while diabetes was a negative predictor of longer AVF survival (P < 0.001; P 5 0.003; P 5 0.043). When comparing patients with normal and low serum protein levels (<65 g/L), mean survival time was significantly longer in patients with normal serum levels (P < 0.001).Discussion: In this study, hypoproteinemia was an independent prognostic marker for AVF failure at 2 years. Hypoproteinemia, based on our results, is an independent, more sensitive and prognostic marker of possible vascular access failure than the presence of other common factors which influence shorter AVF survival.

Predictive Factors for Unsuccessful Use of Arteriovenous Fistula in a Population of End-Stage Renal Disease Patients in Southeastern Mexico

“…Despite all these differences mentioned previously and the lack of a good referral system for AVF creation, we were able to achieve a 77% good successful AVF use (maturation). Our FUHD rate (23%) is actually lower than that of other singlecenter reports (32e46%) 8,9,14 or national results (36%). 12 Our maturation time and cumulative survival are in accordance to what have been previously described elsewhere.…”

“…Our population is younger than that of other studies in which mean age is 55e 65 years. 9,10,12,14,16,18 We found that the presence of diabetes mellitus was not that common in our study, unusual for a 40e70% incidence. 9,11e13,16,17 Similarly, peripheral vascular disease had a lower incidence than other populations (10e20%).…”

“…13,16,18 Our patients had a lower BMI (<25 kg/m 2 ). 13,14,16 Tobacco use and hypertension had a similar incidence in other populations studied for AVF creation. 9,13,14,16 Interestingly, most of the patients had PD as their initial renal replacement therapy; only one patient was referred to AVF before HD commencement.…”

“…13,14,16 Tobacco use and hypertension had a similar incidence in other populations studied for AVF creation. 9,13,14,16 Interestingly, most of the patients had PD as their initial renal replacement therapy; only one patient was referred to AVF before HD commencement. Mexican clinical practice guidelines advocate the PD use as initial renal replacement therapy 19 ; for this reason, PD is the most common form of replacement therapy in Mexico.…”

“…8,10,12,13,15 Similarly, selected laboratory findings have been implicated in the maturation process of AVF maturation, such as hemoglobin, neutrophil-lymphocyte ratio, hypercoagulability, hypoproteinemia, and other inflammatory markers. 9,10,14,18 Nonetheless, the role of these factors is not completely well defined yet.…”