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Abstract: FR-PO466

Role of Neutrophil Extracellular Traps in Vascular Access Thrombosis in Hemodialysis Patients

Session Information

  • Dialysis: Vascular Access
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 803 Dialysis: Vascular Access

Authors

  • Kim, In Soo, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
  • Kim, Ji Hwan, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
  • Jang, Jinha, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
  • Moon, Sung Jin, Catholic Kwandong University International Saint Mary's Hospital, Incheon, Korea (the Republic of)
  • Kim, Sung Gyun, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
  • Kim, Jwa-kyung, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
Background

A patent vascular access (VA) is a lifeline for hemodialysis (HD) patients. However, vascular access is prone to thrombosis, which, if left untreated, can lead to permanent vascular access loss and increased mortality. Previous data have shown that neutrophil dysregulation and excessive release of neutrophil extracellular traps (NETs) may be a key mechanism in both venous and arterial thrombosis. The aim of this study is to evaluate the relationship between circulating NETs and VA thrombotic occlusion and their role in predicting permanent VA loss.

Methods

A total of 173 patients (73 arteriovenous fistula [AVF], 100 arteriovenous graft [AVG]) undergoing VA percutaneous transluminal angioplasty (PTA) with or without thrombectomy were included. Circulating nucleosome and myeloperoxidase (MPO)-DNA complexes were measured as markers of NETs. Serum von Willebrand factor (vWF) was measured as a marker of endothelial damage and thrombosis risk. VA loss was defined as access abandonment requiring dialysis catheter placement.

Results

Thrombectomy was performed in 81 patients. Patients who underwent thrombectomy were significantly older than those who underwent PTA only and used AVG more often than AVF. Circulating nucleosome levels were closely associated with MPO-DNA (r=0.354, p<0.001), serum vWF levels (r=0.172, p=0.025), and previous coronary artery disease (r=0.226, p=0.003). Nucleosome and vWF levels were significantly higher in thrombectomy cases than in PTA cases (nucleosome; 0.83 ± 0.70 vs. 0.35 ± 0.26, p<0.001, vWF: 9.0 ± 7.6 vs. 7.3 ± 6.2, p=0.038). The highest quartile of nucleosomes (Q4) was associated with an 11.4-fold increased risk of VA thrombotic occlusion (p<0.001). In addition, the risk of recurrent thrombotic obstruction within 6 months of PTA was also 3.1 times higher in the nucleosome Q4 group than in the Q1-3 group (p=0.020). During a median follow-up of 34 months, there were 25 cases of VA abandonment. The nucleosome Q4 was strongly associated with an increased risk of access loss (HR 2.56, 95% CI 1.23-7.44, p=0.016) even after adjustment for age, vascular access type, blood pressure, vWF, and duration of access use.

Conclusion

Higher circulating NETs are associated with thrombotic occlusion of VA and subsequent access loss in HD patients.