The osteoporotic effect of arteriovenous fistula on the ipsilateral upper extremity in hemodialysis patients

Abstract

Objective: Hemodialysis requires an arteriovenous fistula (AVF), the presence of which may influence the structure of nearby bone. This study analyzed the effect of AVF on ipsilateral upper extremity bone mineral density (BMD), as measured by phalangeal radiographic absorptiometry (RA). Materials and Methods: In this cross-sectional study, phalangeal BMD was measured in both arms by RA in a convenience sample of end-stage renal disease (ESRD) patients with a forearm AVF. Patients were excluded if the patient had pathology which might affect distal arm circulation. BMD values (g/cm2) from forearms with AVF were compared with values from forearms without AVF. Predialysis values of complete blood count, calcium, phosphorus, alkaline phosphatase, parathyroid hormone, urea, creatinine, potassium, albumin, total cholesterol, HDL cholesterol, and LDL cholesterol were determined in all patients; dialysis adequacy values were also calculated. Results: One hundred and sixteen patients agreed to participate in the study. Thirty-three patients were excluded, thus, data were analyzed from 83 patients (59% male, 41% female, mean hemodialysis time: 156±6 months, mean age: 53±16 years). AVFs were located in the nondominant hand in all patients. Phalangeal BMD in forearms with AVF (0.28±0.05 g/cm2, range: 0.14-0.40) was significantly lower than that in the contralateral forearm (0.30±0.04 g/cm2, range: 0.19-0.40, p<0.05). Conclusion: In ESRD patients on hemodialysis, BMD is lower in the ipsilateral-to-AVF hand compared to the contralateral-to-AVF hand. In these patients, further investigations should be made to ascertain the ability of BMD assessment in determining fracture risk and to prompt physicians to initiate treatments which will preserve BMD and reduce fractures. © Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing.