Effects of comorbidity from AV fistula insufficiency on fistula blood flow rate in hemodialysis patients

Abstract

Background. Arteriovenous fistulas are the most frequently used blood vessel entrances in chronic hemodialysis patients. In this study, we evaluated the appropriateness of arteriovenous fistulas and the association between having a problematic fistula (a fistula unable to reach the required blood flow rate of 350 mL/min) and patient clinical and laboratory values. Patients and Methods. Thirty-eight hemodialysis patients (26 men and 12 women), were included in the study. Their mean age was 58 years, with a range of 35-79 years. Patients were classified according to blood flow rate. Group 1 patients had BFR < 350 mL/min (n = 21) and Group 2 had BFR > 350 mL/min (n = 17). Demographic, clinical, and biochemical data, and fistula location of the 2 groups were compared, and parameters that influence low blood flow were evaluated. Results. No statistically significant differences were found between the groups in age, sex, duration of dialysis, and body mass index (p < 0.05). Serum albumin and hemoglobin levels of the dialysis patients with low BFR were highly significantly lower than in the patients whose BFR was more than 350 mL/min (p < 0.01). Serum calcium times phosphorus (Ca x P) and parathormone levels of the low BFR group were found to be significantly higher than those of the normal BFR group (p < 0.05). There was no statistically significant difference between the groups in total serum cholesterol level (p > 0.05). Evaluation of the effects of hemoglobin, serum albumin, serum Ca x P, and parathormone levels on low blood flow rate during hemodialysis using backward stepwise logistic regression showed the model was highly significant (p < 0.01), with a Negelkerke R2 of 0.790 and an explanatory coefficient of the model of 94.7%. Conclusions. When dialysis was performed at a BFR of less than 350 mL/min, serum albumin, hemoglobin, parathormone levels, and Ca x P product - which all have proven prognostic value - were adversely affected. We observed that serum albumin level and Ca x P product negatively affected low blood flow rate.