Abstract: FR-PO204

An Impairment of the Coagulation-Fibrinolysis System Implicates Vascular Access Patency in Patients on Hemodialysis after Vascular Access Intervention

Session Information

Category: Hypertension

  • 1103 Vascular Biology and Dysfunction

Authors

  • Hasuike, Yukiko, Internal Medicine, Division of Kidney and Dialysis, Nishinomiya, Japan
  • Kakita, Naoto, Internal Medicine, Division of Kidney and Dialysis, Nishinomiya, Japan
  • Kida, Aritoshi, Internal Medicine, Division of Kidney and Dialysis, Nishinomiya, Japan
  • Nanami, Masayoshi, Internal Medicine, Division of Kidney and Dialysis, Nishinomiya, Japan
  • Nakanishi, Takeshi, Internal Medicine, Division of Kidney and Dialysis, Nishinomiya, Japan
Background

Vascular access (VA) is essential for the HD patients. However, VA is often occluded even after the VA intervention therapy (VAIVT). There is increasing evidence indicating the importance of the coagulation-fibrinolysis system in the progression of vascular disease. We intended to clarify whether the imbalance of coagulation-fibrinolysis might be associated with VA failure after VAIVT.

Methods

Blood samples were taken from 462 HD patients at the VAIVT. Among them, 352 patients (76.2%) had native arteriovenous fistula (AVF). Thrombin/anti-thrombin (TAT) as a marker of coagulation, plasmin-α2-plasmin inhibitor complex (PIC) as markers of fibrinolysis, and factors related to inflammation (CRP, interleukin-6, tumor necrosis factor-α, pentraxin-3), mineral-bone metabolism (calcium, phosphate, parathyroid hormone), and uremia were measured. Blood flow volume (FV) of VA was evaluated by Doppler ultrasonography before VAIVT. The end point was the re-vascularization or re-operation of VA during the observational period after VAIVT (mean follow-up periods 278.7±182.8 days). The results were analyzed using receiver operating characteristic curve, Kaplan-Meier methods, and Cox regression analyses.

Results

Age of patients was 69.9±10.6 years, and 225 female patients (48.7%). During follow-up period, re-VAIVT was performed in 82 patients and re-operation in 80 patients. The Kaplan-Meier analysis showed that the patients with lower FV (<344 ml/min), graft AVF, and higher TAT/PIC ratio (≥4.17) were associated with poor patency rates [figure A, B, C]. Cox regression analysis revealed that higher TAT/PIC ratio (adjusted HR 1.67, 95%CI 1.14 to 2.43, p=0.008) was linked to VA failure event.

Conclusion

The impaired coagulation-fibrinolysis system as well as lower FV and graft VA can affect VA failure after VAIVT.