Analysis of influencing factors for arteriovenous graft dysfunction in hemodialysis patients / 中华肾脏病杂志

ABSTRACT

Objective:To explore the influencing factors of arteriovenous graft (AVG) dysfunction in hemodialysis (HD) patients, and provide a basis for predicting the risk of dysfunction and prolonging the service time.Methods:Retrospective analysis was performed on the clinical and follow-up data of patients who underwent AVG surgery in Department of Vascular and Interventional Surgery, Nanfang Hospital, Southern Medical University from January 2013 to September 2018. The factors of AVG dysfunction were determined by statistical methods.Results:A total of 139 patients were enrolled, including 58 males (41.7%); the median age was 57; in which 83 patients (59.7%) developed AVG dysfunction within 24 months. Kaplan-Meier survival analysis showed that the primary patency rates were 76.1%, 56.8%, and 38.5% at 6, 12, and 24 months after the establishment of AVG. The results of Kaplan-Meier survival analysis showed that at 24 months after surgery, the risk of AVG dysfunction in elderly patients (>65 years old) was significantly higher than that of patients≤65 years old (Log-rank χ2=7.632, P=0.006); the risk of AVG dysfunction in patients with mean platelet volume (MPV)>10.1 fl was significantly higher than that of patients with MPV≤10.1 fl (Log-rank χ2=19.910, P<0.001); the risk of AVG dysfunction in patients with platelet distribution width (PDW)>11.4 fl was significantly higher than that of patients with PDW≤11.4 fl (Log-rank χ2=35.410, P<0.001); the risk of AVG dysfunction in patients with platelet-larger cell ratio (P-LCR)>24.8% was significantly higher than that of patients with P-LCR≤24.8% (Log-rank χ2=7.181, P=0.007). Multivariate Cox proportional risk regression analysis showed that high MPV (MPV>10.1 fl, HR=6.501, 95% CI 1.916-22.054, P=0.003), high PDW (PDW>11.4 fl, HR=3.625, 95% CI 1.957-6.714, P<0.001) and low P-LCR (P-LCR>24.8%, HR=0.145, 95% CI 0.045-0.470, P=0.001) were independent influencing factors for AVG dysfunction. The establishment of a functional prediction equation based on the above factors had a certain value in predicting the risk of AVG dysfunction in HD patients (likelihood ratio test χ2=49.360, P<0.001). Conclusions:There are multiple factors that affect AVG dysfunction in HD patients, among which MPV, PDW and P-LCR levels may be the influencing factors for AVG dysfunction. Preoperative examination or postoperative comprehensive review of these factors during the follow-up period has certain directive significance for the prevention of AVG dysfunction.