Impact of Vascular Calcifications on Arteriovenous Fistula Survival in Hemodialysis Patients: A Five-Year Follow-Up

Janković, Aleksandar; Damjanović, Tatjana; Djurić, Živka; Marinković, Jelena; Schlieper, Georg; Tosic-Dragovic, Jelena; Djuric, Petar; Popović, Jovan; Floege, Juergen; Dimković, Nada

doi:10.1159/000380823

Cited by 24 publications

(20 citation statements)

References 26 publications

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“…For example, Lee et al [39] have documented the presence of vascular calcification in upper extremity vessels used to create new vascular access. Studies have found that preexistent vascular calcification is associated with worse survival of native AVF [40,41]. The preexistent vascular calcification may be less relevant in AVG compared to AVF.…”

Section: Discussionmentioning

confidence: 99%

Vascular Calcification Markers and Hemodialysis Vascular Access Complications

et al. 2018

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Background: Arteriovenous (AV) access dysfunction is a common complication in hemodialysis patients. Markers of vascular calcification are associated with cardiovascular outcomes and mortality in this population, but their association with vascular access outcomes is unknown. In this study, we aimed to evaluate the association between selected vascular calcification makers and vascular access complications in a cohort of hemodialysis patients. Method: Fetuin-A, osteopontin (OPN), osteoprotegerin (OPG), and bone morphogenetic protein-7 (BMP-7) were measured in blood samples from 219 dialysis patients in the Choice for Healthy Outcomes in Caring for end-stage renal disease study; these patients were using a permanent vascular access. Participants were followed for up to 1 year or until the occurrence of a vascular access intervention or replacement. Associations with AV fistula (AVF) and AV graft (AVG) intervention-free survival were assessed in models adjusted for demographic characteristics, comorbidities, and inflammation. Results: A total of 24 out 103 participants with an AVF and 43 out of 116 participants with an AVG had an intervention during follow-up. Lower fetuin-A, higher OPN, and higher BMP-7 were associated with a higher risk of AVF intervention (adjusted hazard ratios [aHR] for highest versus lowest tertile = 0.30 [95% CI 0.10–0.94]) for fetuin-A, 3.84 (95% CI 1.16–12.74) for OPN, and 3.49 (95% CI 1.16–10.52) for BMP-7. OPG was not significantly associated with the risk of AVF intervention. The associations of OPN and BMP-7 with AVF intervention appeared stronger among participants without diabetes (aHR 8.06; 95% CI 1.11–58.57 for OPN and aHR 2.55; 95% CI 1.08–6.08 for BMP-7, respectively) than among their counterparts with diabetes (p interaction = 0.06). None of the markers studied were significantly associated with AVG interventions. Conclusion: Lower fetuin-A and higher OPN and BMP-7 are associated with complications in AVF but not in AVG, suggesting a role for calcification in the pathogenesis AVF failure.

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Section: Discussionmentioning

confidence: 99%

Vascular Calcification Markers and Hemodialysis Vascular Access Complications

et al. 2018

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“…Calcification severity in patients on hemodialysis with working AVFs as determined by radiology correlated with worse AVF patency in a 5-year follow-up study (49). In contrast, using histologic analysis, preexisting microcalcification in arteries used for AVF creation did not predict postoperative stenosis, AVF maturation, or primary unassisted patency (38,50).…”

Section: Vascular Calcification and Avf Outcomesmentioning

confidence: 91%

New Insights into Dialysis Vascular Access: Impact of Preexisting Arterial and Venous Pathology on AVF and AVG Outcomes

Vázquez-Padrón

Allon

2016

CJASN

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Despite significant improvements in preoperative patient evaluation and surgical planning, vascular access failure in patients on hemodialysis remains a frequent and often unforeseeable complication. Our inability to prevent this complication is, in part, because of an incomplete understanding of how preexisting venous and arterial conditions influence the function of newly created arteriovenous fistulas and grafts. This article reviews the relationship between three preexisting vascular pathologies associated with CKD (intimal hyperplasia, vascular calcification, and medial fibrosis) and hemodialysis access outcomes. The published literature indicates that the pathogenesis of vascular access failure is multifactorial and not determined by any of these pathologies individually. Keeping this observation in mind should help focus our research on the true causes responsible for vascular access failure and the much needed therapies to prevent it.

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“…Patients with visibly calcified arteries on radiography had inferior primary and secondary patency at 4-year follow-up as well as inferior total survival at 2 years. Jankovic et al 45 found that the degree of arterial calcification is strongly associated with access failure, with increasing degrees of calcification correlated with greater probability of access failure. Masengu et al 21 used duplex ultrasound-derived volume flow as a substitute for arterial diameter in 152 patients undergoing access creation.…”

Section: Journal Of Vascular Surgerymentioning

confidence: 99%

Influence of artery and vein diameters on autogenous arteriovenous access patency

Misskey

Hamidizadeh

Faulds

et al. 2020

Journal of Vascular Surgery

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Objective: Previous investigations have suggested that a minimum venous outflow diameter (MVOD) and perianastomotic arterial diameter are associated with successful autogenous arteriovenous maturation and patency. The goal of this study was to determine anatomic and clinical variables that may influence access patency to guide optimal autogenous access configuration selection. Methods: Accesses created from 2010 to 2016 were analyzed from data entered into a prospective database. Preprocedure duplex ultrasound mapping data of artery and tourniquet-derived vein diameters and demographic and clinical variables were collected. Survival-based cut point analysis was used to determine anatomic parameters most predictive of access failure. Kaplan-Meier and Cox proportional hazards analyses were used to assess patencies and maturation and to identify independent predictors of access failure. Results: A total of 356 first-time autogenous accesses were created (median follow-up, 20 months; range, 0-73 months). Of these, 202 (56.7%) were radiocephalic and 154 (43.3%) were brachiocephalic. Maturation failure at end of follow-up for arteriovenous accesses was 26% 6 3% for radiocephalic accesses and 15% 6 3% for brachiocephalic accesses (P < .001). For radiocephalic accesses, MVOD <3.0 mm and radial artery diameter <2.1 mm independently predicted access maturation failure (MVOD <3.0 mm: hazard ratio [

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Impact of Vascular Calcifications on Arteriovenous Fistula Survival in Hemodialysis Patients: A Five-Year Follow-Up

Cited by 24 publications

References 26 publications

Vascular Calcification Markers and Hemodialysis Vascular Access Complications

Vascular Calcification Markers and Hemodialysis Vascular Access Complications

New Insights into Dialysis Vascular Access: Impact of Preexisting Arterial and Venous Pathology on AVF and AVG Outcomes

Influence of artery and vein diameters on autogenous arteriovenous access patency

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