Study On Chronic Risk Factors For The Failure Of Mature Autogenous Arteriovenous Fistula

Objective:By observing the general condition,dialysis indexs,inflammation and nutritional metabolism of maintenance hemodialysis(MHD)patients,the chronic risk factors were investigated for the failure of mature autogenous arteriovenous fistula(AVF).Methods:Strict adherence to inclusion and exclusion criteria,a retrospective case-control analysis was made of 248 patients in two hemodialysis centers.The average age which AVF was established was(46.847±11.825)years old.It included 151 males and 97females.Depending on whether AVF was loss,the patients were divided into the failure group(n=53)and the functional group(n=195).AVF'average service life of the patients was(42.642±28.672)months in the failure group.According to the regulations collecting the relevant data,Chi-square test were used to contrast enumeration datas such as gender,age of establishing AVF and the primary disease in two groups of patients.According to the variance situation,t test were used to contrast measurement datas such as initial blood flow of AVF,age of dialysis,high flux dialysis time,total dialysis time,white blood cell count,C-reactive protein,serum albumin,serum calcium,serum phosphorus,the calcium-phosphorus product,serum parathyroid hormone,serum cholesterol,serum triglycerides and prothrombin time in two groups of patients.Using above methods,the related factors of mature AVF loss were analyzed.By using logistic regression,all observation indexes were analyzed for exploring the independent risk factors for mature AVF loss.Results:1.There were no statistically significant difference in gender(c~2=0.007,P=0.932),age of establishing AVF(c~2=5.803,P=0.055),initial blood flow of AVF(t=-1.662,P=0.098),age of dialysis(t=0.284,P=0.509),white blood cell count(t=0.977,P=0.331),serum albumin(t=0.656,P=0.512)and prothrombin time(t=-1.639,P=0.102)between two groups of patients.2.There were statistically significant differences in the primary disease(c~2=8.809,P=0.032),high flux dialysis time(t=-5.453,P=0.000),total dialysis time(t=-3.158,P=0.002),C-reactive protein(t=2.325,P=0.02),serum calcium(t=-3.404,P=0.001),serum phosphorus(t=4.135,P=0.000),the calcium-phosphorus product(t=2.585,P=0.012),serum parathyroid hormone(t=3.528,P=0.001),serum cholesterol(t=5.951,P=0.000)and serum triglycerides(t=2.054,P=0.041)between two groups of patients.3.The MHD patients with diabetic nephropathy was at higher risk of mature AVF loss(OR=8.652 OR95%CI:2.111-35.460,P=0.003).The MHD patients with hypertension nephropathy was at higher risk of mature AVF loss(OR=7.300 OR95%CI:1.537-34.672,P=0.012).The MHD patients with lighter degree of hypocalcemia was at lower risk of mature AVF loss(OR=0.066 OR95%CI:0.007-0.611,P=0.017).The MHD patients with elevated serum phosphorus was at higher risk of mature AVF loss(OR=6.323 OR95%CI:1.881-21.253,P=0.003).The MHD patients with elevated serum parathyroid hormone was at higher risk of mature AVF loss(OR=1.002 OR95%CI:1.001-1.004,P=0.007).The MHD patients with elevated serum cholesterol was at higher risk of mature AVF loss(OR=5.570 OR95%CI:2.598-11.943,P=0.000).The MHD patients with long high flux dialysis time was at lower risk of mature AVF loss(OR=0.765 OR95%CI:0.666-0.878,P=0.000).Conclusion:1.The primary disease,high flux dialysis time,total dialysis time,C-reactive protein,serum calcium,serum phosphorus,the calcium-phosphorus product,serum parathyroid hormone,serum cholesterol and serum triglycerides were correlated with mature AVF loss.2.Diabetic nephropathy,hypertension nephropathy,calcium phosphorus metabolism disorder and lipid metabolism disorder were the independent risk factors for mature AVF loss.3.It was helpful to increase high flux dialysis time for protecting mature AVF in the clinical work.