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Kidney Week

Abstract: PO1342

Association Between FGF-23 Serum Levels with the Maturation Process of a Native Arteriovenous Fistula in Patients with End-Stage CKD

Session Information

  • Vascular Access
    October 22, 2020 | Location: On-Demand
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 704 Dialysis: Vascular Access

Authors

  • Reyna-Blanco, Juan, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
  • Perez-Navarro, L. Monserrat, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
  • Valdez-Ortiz, Rafael, Hospital General de Mexico Dr Eduardo Liceaga, Ciudad de Mexico, Ciudad de Mexico, Mexico
Background

The process of maturation of an arteriovenous fistula (AVF) is complex and difficult to predict. It is known that high levels of fibroblast growth factor 23 (FGF-23) could be related to endothelial dysfunction, which could also influence the maturation of an AVF. Our goal is to know the association between serum levels of FGF-23 and the maturation of an AVF

Methods

This is a prospective cohort study with patients who underwent an AVF. The primary outcome was ultrasonic maturation at 6 weeks defined by the Birmingham criteria (diameter >0.4 cm and blood flow more than 500 ml/min).

Results

Forty-nine patients with a mean age of 48 ±14 years were included and 24% were women. The most common cause of CKD was diabetic nephropathy (55%). 49%, 25%, 10% and 16% were brachycephalic, brachyimedian, brachybasylic and other AVF respectively. thirty nine percentage of AVFs did not mature at 6 weeks. No significant differences were identified when comparing the agreement with maturation or not of the AVF in age, comorbidities, BMI, previous number of hemodialysis catheters, history of thrombosed catheter or catheter infection, hemodialysis vintage, residual diuresis, surgical time, hemoglobin, creatinine and serum calcium or phosphorus. However, the length of the arteriotomy was greater in the fistulas that do not mature with respect to the mature fistulas (7 mm vs. 6 mm p = 0.03). Likewise, the use of loop diuretics was more prevalent in AVF that did not mature (without maturation: 74% vs. maturation: 43%, p = 0.03). None of the distal radiocephalic AVF reached maturity. There were no association between serum levels of cFGF-23 and maturation of AVF, nor was the correlation between serum levels of cFGF-23 and the diameter or flow of the fistulas at six weeks.

Conclusion

The prevalence of maturation failure in AVFs was 39% according to Birminghams criteria. There is no correlation between serum levels of cFGF-23 and the flow or diameter of the AVF at six weeks. A larger population is required to corroborate these results.