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Abstract: TH-PO348

Risk Factor Profile for Thrombophilia in Patients with ESRD on Maintenance Hemodialysis with Recurrent Arteriovenous Fistula Clotting

Session Information

  • Vascular Access - I
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Reddy, Sunnesh, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
  • Yalamanchili, Venkata A., Dallas Nephrology Associates, DeSoto, Texas, United States
  • Devi, Harini Nimmanapalli, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
  • Pvgk, Sarma, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
  • Sameera, Sai Nannapaneni, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
  • Vishnubotla, Siva Kumar, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
  • Rapur, Ram, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
Background

Vascular access is critically important for hemodialysis patients, being both a lifeline and an Achille's heel. Failure of arteriovenous fistula (AVF) has a substantial impact on the patient in terms of economic burden, morbidity and all-cause mortality. Thrombosis is the leading cause of AVF failure accounting for 80-85% of AV access loss. Since limited number of well-established risk factors for access thrombosis are known, in the present study we evaluated the relation between hereditary and acquired thrombotic factors contributing to recurrent AVF thrombosis. We also studied the association between recurrent AVF thrombosis with thrombotic factors in comparison with well-functioning fistulas and its association with ABO blood group, age, gender and diabetes.

Methods

This is a cross-sectional observational study with a total of 100 hemodialysis patients. 50 patients with recurrent AVF failure secondary to access thrombosis served as cases and 50 patients with well working AVFs as controls. Parameters studied are hereditary thrombotic factors- Factor V leiden (G1691A ), Factor XIII ( val34leu ), Prothrombin (G20210A), MTHFR (C677T) by DNR isolation and PCR products and acquired thrombotic factors - Lipoprotein (a), Fibrinogen using immunoturbidimetry, Homocysteine by enzyme recyclic and Anticardiolipin antibody(IgG and IgM) by ELISA method.

Results

In our study hereditary factors were not significantly different between the two groups but acquired factors Lipoprotein (a), Fibrinogen, Homocysteine, Anticardiolipin Antibody IgG and IgM were found to be elevated in patient with recurrent AVF thrombosis when compared to controls (P 0.001). There was significant association between recurrent vascular access thrombosis and non O blood groups (P 0.047). Anemia (Hb < 10 gm/dl) was observed in patients with recurrent vascular access thrombosis when compared to well working fistulas. We did not find a significant association between age, gender and presence of diabetes contributing to recurrent vascular access thrombosis (P 0.826).

Conclusion

Acquired thrombotic factors contribute to recurrent AVF clotting in patients on maintenance hemodialysis. Recurrent AVF thrombosis is more common in non-O blood group and in patients with anemia.