The influence of atherosclerosis and plasma D-dimer concentration in patients with a functioning arteriovenous fistula for maintenance hemodialysis

Objective The aim of this study was to deduce the influence of atherosclerosis and plasma D-dimer concentration on the functioning of arteriovenous fistulae for hemodialysis. Methods The study was organized as a prospective and non-randomized investigation in the “Kragujevac” Clinical Center. The 81...

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Published in:International urology and nephrology 2008-01, Vol.40 (2), p.503-508
Main Authors: Stolic, Radojica V., Trajkovic, Goran Z., Peric, Vladan M., Jovanovic, Aleksandar N., Markovic, Snezana R., Sovtic, Sasa R., Subaric-Gorgieva, Gordana Dj
Format: Article
Language:English
Subjects:
Age Factors
Aged
Anemia - epidemiology
Arteriovenous Shunt, Surgical
Atherosclerosis - blood
Atherosclerosis - epidemiology
Carotid Arteries - diagnostic imaging
Comorbidity
Female
Fibrin Fibrinogen Degradation Products - analysis
Humans
Kidney Failure, Chronic - epidemiology
Male
Medicine
Medicine & Public Health
Middle Aged
Nephrology
Original Article
Renal Dialysis
Smoking - epidemiology
Treatment Failure
Ultrasonography, Doppler
Urology
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Summary:Objective The aim of this study was to deduce the influence of atherosclerosis and plasma D-dimer concentration on the functioning of arteriovenous fistulae for hemodialysis. Methods The study was organized as a prospective and non-randomized investigation in the “Kragujevac” Clinical Center. The 81 examined patients, 49 (60.5%) males and 32 (39.5%) females, were divided into a group ( n  = 36) requiring several attempts to create arteriovenous fistulae for hemodialysis and a group ( n  = 45) with no complications of arteriovenous fistulae for hemodialysis. The demographic structure, etiology of renal disease, biochemical parameters and concentration of D-dimer were analyzed at the beginning of the study and 1 year later, as well as the existence of tissue calcification and Duplex ultrasound parameters of the carotid artery. Results The patients with arteriovenous fistulae complications were significantly older (58.4 ± 12.9 vs. 52.3 ± 11.6 years; P  = 0.026). High venous pressure (98.6 ± 29.98 vs. 80 ± 33.57 mmHg; P  = 0.005) and soft-tissue calcification ( P  = 0.03) were correlated with the occurrence of arteriovenous fistula complications. The greatest risk for failure of fistula was within the first month after creation of the anastomosis (failure rate was 0.235). The hemoglobin concentration (89 ± 14.0 vs. 96.6 ± 17.7 g/l; P  = 0.048) was lower, and concentration of D-dimer at the end of the study was higher (219.56 ± 193.05 vs. 332.03 ± 149.48; P  = 0.012) in patients with vascular access complications. By Cox regression analysis, the concentration of fibrin D-dimer at the end of the study was shown to be a significant predictor of fistula survival (β = 0.002; P  = 0.006). Conclusions Complications of arteriovenous fistulae were more often recorded in older patients. The greatest risk for fistula functioning was within the first month after creation of the anastomosis. Vein pressure and anemia were important indicators of arteriovenous fistula complications. D-dimer was a significant marker of arteriovenous fistula thrombosis.
ISSN:0301-1623
1573-2584
DOI:10.1007/s11255-007-9321-8