Abstract: TH-PO766

CKD-Mineral Bone Disorder and Risk of Maturation Failure in Hemodialysis Arteriovenous Fistula

Session Information

Category: Dialysis

  • 603 Hemodialysis: Vascular Access

Author

  • Liu, Chung-te, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
Background

Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. However, instant usability of this vascular access type is limited by high rates of maturation failure. Chronic kidney disease-mineral bone disorder (CKD-MBD) is associated systemic vascular calcification and increased mortality in dialysis patients. While CKD-MBD correlates with cardiovascular disease in dialysis patients, the association between CKD-MBD and maturation failure of AVF remains to be elucidated.

Methods

A retrospective cohort study was conducted to enroll patients receiving AVF creation and maintenance hemodialysis in Wanfang Hospital, Taipei Medical University from January, 2004 to February, 2017. The outcome of the study was maturation failure of AVF, which was defined as non-usage of the AVF for hemodialysis from its creation to the establishment of another hemodialysis vascular access. Predictors included baseline demographic profiles and laboratory data. Categorical and continuous variables were compared using chi square test and two-tailed t-test for unpaired samples, respectively. The association of predictors to outcome was tested using logistic regression.

Results

During the study period, 408 patients receiving AVF creation and maintenance hemodialysis were included. Among the included patients, the mean age was 56.6±13.7 years. In addition, 56.4% were male and 49.3% had diabetes. Fifty-nine (14.5%) patients had maturation failure. Compared with patients with mature AVF, the maturation failure patients had significantly more diabetes, higher serum glucose and parathyroid hormone (PTH) levels. Serum calcium, phosphorus and other laboratory tests were not significantly different between the two groups. Univariate logistic regression showed that diabetes and serum PTH were significantly associated with maturation failure. In multivariate logistic regression, only PTH remained significantly associated with maturation failure. The above findings showed that higher PTH level was associated higher risk of AVF maturation failure.

Conclusion

This study preliminarily showed the association between higher PTH level and AVF maturation failure. This finding indicate that secondary hyperparathyroidism may have detrimental effect on successful rate of AVF creation.