Abstract: TH-PO755

Vascular Histology of Upper Extremities in Patients with CKD and Normal Controls

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Authors

  • Shiu, Yan-Ting, University of Utah, SALT LAKE CITY, Utah, United States
  • Litovsky, Silvio H., University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Tey, CS Jason, University of Utah, SALT LAKE CITY, Utah, United States
  • Sundberg, Chad A., University of Utah, SALT LAKE CITY, Utah, United States
  • Zhang, Y., University of Utah, SALT LAKE CITY, Utah, United States
  • Cheung, Alfred K., University of Utah, SALT LAKE CITY, Utah, United States
  • Allon, Michael, University of Alabama at Birmingham, Birmingham, Alabama, United States
Background

Several studies have documented histologic features in the peripheral arteries and veins of patients with chronic kidney disease (CKD), but few have compared them to the vascular histology observed in control subjects.

Methods

We obtained upper extremity arterial and venous specimens used to create arteriovenous fistulas from 125 CKD patients, and from 15 cadavers with no CKD. Intimal hyperplasia was quantified using elastic stains as well as hematoxylin and eosin stains, medial fibrosis using Masson’s trichrome stains, and micro-calcification using von Kossa stains. Second-harmonic-generation microscopy was used to quantify the anisotropy index (measure of randomness of fiber orientation, ranging from 0 for completely random to 1 for completely aligned) and the dominant direction of the medial collagen fibers (measure of the angle of the fibers relative of the vascular lumen, ranging from 0o (parallel with lumen) to 90o (perpendicular to lumen)).

Results

The CKD patients were significantly younger (53±14 vs 76±11 yr; p<0.001). As compared to the control subjects, the CKD patients had greater arterial medial fibrosis (69±14 vs 51±10%, p<0.001), greater arterial micro-calcification (3.03±5.17 vs 0.01±0.03%, p<0.001), and greater venous intimal thickness 37±40 vs 14±6 um, p<0.001), but less arterial intimal thickness (30±25 vs 63±25 um, p<0.001). The anisotropy index of the collagen fibers was lower in both arteries (0.24±0.10 vs 0.44±0.04, p<0.001) and veins (0.28±0.09 vs 0.53±0.10, p<0.001) obtained from CKD patients. The dominant medial direction of the collagen fibers in CKD patients was greater in the arteries (49.3±23.6 vs 4.0±2.0, p<0.001) and the veins (30.0±19.6 vs 3.9±2.1, p<0.001).

Conclusion

CKD is associated with greater arterial medial fibrosis, arterial micro-calcification and venous intimal hyperplasia, but less arterial intimal hyperplasia than that present in control subjects. In addition, the collagen fibers in the arteries and veins of CKD patients are oriented more randomly and more perpendicular to the vascular lumen. The vascular histology in CKD patients may affect the maturation outcomes of arteriovenous fistulas.

Funding

  • NIDDK Support