Effects Of Different Vascular Access On Micro-inflammatory Status And Infection With Maintenance Hemodialysis: A Propensity Score-matched Analysis

Background: Currently,chronic kidney disease(CKD)has become one of the major diseases that threaten public health worldwide.At least 2.4 million people died due to CKD each year,which is currently the 11 th highest mortality rate in the world.Once CKD occurs,itis irreparable and eventually progressing to end-stage renal disease(ESRD)and needs renal replacement therapy(Renal replacement therapy,RRT).Among them,hemodialysis is one of the most widely used RRT,and vascular access is the lifeline for patients with long-term dialysis treatment.However,complications of vascular access have caused a significant burden on patients with long-term hemodialysis,which can increase the patient’s economical cost and risk of death.Microinflammation is very common in maintenance hemodialysis patients,which can promote vascular calcification,leading to cardiovascular and cerebrovascular diseases,increasing anemia,and malnutrition.Previous studies have confirmed that microinflammation leads to the narrowing of arteriovenous fistula and vascular access failure.Permanent Tunneled Cuffed Venous(TCV)can also promote the expression of inflammatory markers.However,the level of inflammation markers and their relationship with vascular types in hemodialysis patients remains a controversy.Therefore,to analyze the effects of different types of vascular access on micro-inflammatory status and infection with maintenance hemodialysis have crucial clinical value and practical significance.Objective: To study the effects of arteriovenous fistula vs.tunneled cuffed venous catheter on the microinflammation status and infection in patients with maintenance hemodialysis.Methods: A total of 256 patients with long-time maintenance hemodialysis admitted between September 2018 and September 2019 were divided into Arteriovenous fistula(AVF,n=204)group or Tunneled Cuffed Venous catheter(TCV,n=52)group according to the type of vascular access for dialysis.In the53.56 years;while in the TCV group,there were 26 males and 26 females,with an average age of 59.55 years.Blood samples were taken from patients before the dialysis section.Blood routine and biochemical parameters including uric acid,creatinine,serum albumin,calcium,phosphorus,whole parathyroid hormone(PTH),and serum C-reactive protein(CRP)were examined by the full-automatic biochemical analyzer,while Tumor necrosis factor-alpha(TNF-α),interleukin-1(IL-1)and IL-6 were measured by ELISA kit.At the same time,the infection events of patients within 3 months were recorded.The propensity-matched analysis was used to explore the differences between conventional biochemical indicators and inflammation markers between the AVF group and the TVC group.Results: After matching the propensity score between the AVF group and the TCV group,there was no difference in gender and age between the two groups, and the groups were comparable.For biochemical parameters,compared with the TCV group,the total calcium and serum albumin levels in the AVF group were lower,while the levels of uric acid,urea nitrogen,creatinine URR and Kt/Vwere significantly higher(p<0.05).There was no significant difference in phosphorus and whole parathyroid hormone(PTH)between the two groups(p>0.05).For inflammation markers,Compared with TCV group,the serum CRP and IL-1 were significantly lower in the AVF group,while the TNF-α was higher with statistically significant(p<0.05),while IL-6 showed no significant difference(p>0.05).Moreover,there was no difference in infection rates between the two groups(p=0.841).Besides,Rank correlation analysis was performed and showed that urea nitrogen was negatively correlated with serum CRP,serum albumin was positively correlated with IL-1;urea nitrogen was negatively correlated with IL-1,TNF-α was negatively correlated with serum albumin.The multiple linear regression analysis indicates that the type of vascular access was an independent influencing factor for CRP and IL-1.The average serum CRP level of the patients in the TCV was 7.632 mg/ml higher than that of the AVF group,and the average serum IL-1 level in the TCV group was higher than the AVF group.At last,the types of vascular access had no effect on IL-6 and TNF-α.Conclusion: 1.Compared with the AVF,TCV catheter is more likely to aggravate the microinflammation state in maintenance hemodialysis treatment;2.TVC catheters may be one of the causes of microinflammatory state in patients with maintenance hemodialysis treatment.