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Abstract: FR-PO707

Neutrophil Activation Status Was Associated with the Degree of Arteriovenous Fistula Stenosis in Chronic Hemodialysis Patients

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Choi, Hye Min, Myongji Hospital, Goyang-si, Korea (the Republic of)
  • Kwon, Young Eun, Myongji Hospital, Koyang, Korea (the Republic of)
  • Oh, Dong-jin, Myongji Hospital, Koyang, Korea (the Republic of)
Background

Although arteriovenous fistula (AVF) dysfunction is a major cause of morbidity in hemodialysis (HD) patients, detailed pathogenesis of AVF stenosis is still under investigation.
Leukocytes have been shown to play an important role in the development AVF stenosis. However, prior reports have focused on monocyte lineage cells, and little is known about the possible role of neutrophils.
We aimed to evaluate the association between AVF stenosis and neutrophil activation status by measuring circulating levels of neutrophil elastase (NES), lactoferrin, and angiogenin, which are markers of neutrophil activation and inhibition, respectively.

Methods

A total of 69 patients were included who received HD with native AVF for more than 3 months. Patients with recent history of infection, antibiotics, or AVF intervention were excluded. Degree of AVF stenosis was expressed by the percent of the greatest stenotic diameter to the widest adjacent vessel diameter by ultrasound

Results

The pre-dialysis circulating NES and lactoferrin levels were not significantly different between HD patients and control (healthy and CKD stage 3), although angiogenin level was significantly higher in HD population.
The degree of AVF stenosis was positively correlated with NES (r=0.360, p=0.002) and lactoferrin (r=0.352, p=0.003) levels.
Patients with AVF stenosis (stenosis > 50%) were older (65.9±9.7 vs 58.0±13.7, p=0.004), had longer duration of AVF use (52.9±45.8 vs 39.5±46.0 month, p=0.019), higher hsCRP (0.34±0.35 vs 0.15±0.17 mg/dl, p=0.029), and higher NES (421.0±254.2 vs 192.2±136.3 ng/ml, p<0.001) and lactoferrin (279.4±127.4 vs 144.0±68.9 ng/ml, p=0.001) levels compared with the other group. There was no significant difference in gender, presence of diabetes, angiogenin, and other biochemical measurements including albumin, calcium, phosphorus, iPTH, and cholesterols according to the degree of AVF stenosis. In multivariable analysis, however, only age and duration of AVF use were statistically significant factors for AVF stenosis.

Conclusion

Circulating levels of NES and lactoferrin, indirect markers of neurophil activation, were associated with the degree of AVF stenosis. Larger scales of long-term prospective studies are needed to show whether they could be used as independent predictors of at-risk AVF.