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Objetivo: Determinar los factores inflamatorios, bioquímicos y hematológicos pre-quirúrgicos y post-quirúrgicos que influyen en la maduración de las fistulas arteriovenosas nativas .
Material y Método: Estudio observacional retrospectivo. Se realizaron dos analíticas sanguíneas, pre-quirúrgica y post-quirúrgica, analizando parámetros bioquímicos, hematológicos, e inflamatorios. Análisis estadístico: Descriptivo. T-Student, U de Mann-Whitney y Chi cuadrado. Prueba de Wilcoxon y regresión logística binomial.
Resultados: Muestra de 130 pacientes, edad media 68,3 años. 75,3% hombres. 75,3% fístulas maduras. Al comparar las fístulas maduras frente a las no maduras observamos: Analítica pre-quirúrgica: albumina (p=0,012) y PO2 (p=0,007) significativamente mayores, y PCR (p=0.006) significativamente menor en fístulas maduras. Analítica post-quirúrgica: PCR (p=0.004) y creatinina (p=0,002) significativamente menores en fístulas maduras. Análisis de muestras apareadas: en fístulas maduras: incremento significativo de PO2 (p=0,049), leucocitos (p=0,021) y neutrófilos (p=0,011) post-quirúrgicos, y descenso significativo de PCO2 (p=0,042) y creatinina (p<0,001) post-quirúrgicas. En fístulas no maduras: descenso significativo de albumina pre-quirúrgica (p<0,001). Regresión logística: a mayor valor pre-quirúgico de albumina (OR:0,15;p=0,003) y PO2 (OR:0,54;p=0,002) menor riesgo de fallos de maduración. A mayores valores pre-quirúrgicos de ácido úrico (OR:1,58; p=0,005), y post-quirúrgicos de PCR (OR:1,31; p=0,047) y creatinina (OR:1.22; p=0,006) mayor riesgo de fallos de maduración.
Conclusiones: Valores elevados de ácido úrico, creatinina y PCR aumentan el riesgo de fallos de maduración; una mayor albúmina y P02 pre-quirúrgicas lo reducen. Tras la cirugía, en fístulas maduras se observa un incremento de PO2, leucocitos y neutrófilos, y un descenso significativo de PCO2 y creatinina.
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Derechos de autor 2025 FRANCISCO JAVIER RUBIO CASTAÑEDA, MANUEL FERNANDEZ NUÑEZ, JOHANNA CHICO GUERRA, ANA ISABEL SIERRA SÁNCHEZ, EMILIA FERRER LÓPEZ, MARIA AMAYA MATEO SANCHEZ
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
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Referencias
- Brahmbhatt A, Remuzzi A, Franzoni M, Misra S. The molecular mechanisms of hemodialysis vascular access failure. Kidney Int. 2016;89(2):303-16. DOI: https://doi.org/10.1016/j.kint.2015.12.019
- Duque JC, Martinez L, Tabbara M, Dvorquez D, Mehandru SK, Asif A, Vazquez-Padron RI, Salman LH. Arteriovenous fistula maturation in patients with permanent access created prior to or after hemodialysis initiation. J Vasc Access. 2017;18(3):185-91. DOI: https://doi.org/10.5301/jva.5000662
- Gameiro J, Ibeas J. Factors affecting arteriovenous fistula dysfunction: A narrative review. J Vasc Access. 2020;21(2):134-47. DOI: https://doi.org/10.1177/1129729819845562
- Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G , Martí-Monrós A, et al. Guía clínica española del acceso vascular para hemodiálisis. Nefrología. 2017;37:1-177. DOI: https://doi.org/10.1016/j.nefro.2017.11.004
- Siddiqui MA, Ashraff S, Carline T. Maturation of arteriovenous fistula: Analysis of key factors. Kidney Res Clin Pract. 2017;36(4):318-28. DOI: https://doi.org/10.23876/j.krcp.2017.36.4.318
- Zhang F, Li J, Yu J, Jiang Y, Xiao H, Yang Y, Liang Y, Liu K, Luo X. Risk factors for arteriovenous fistula dysfunction in hemodialysis patients: a retrospective study. Sci Rep. 2023;13(1):21325. DOI: https://doi.org/10.1038/s41598-023-48691-4
- Hu H, Patel S, Hanisch JJ, Santana JM, Hashimoto T, Bai H, Kudze T, Foster TR, Guo J, Yatsula B, Tsui J, Dardik A. Future research directions to improve fistula maturation and reduce access failure. Semin Vasc Surg. 2016;29(4):153-71. DOI: https://doi.org/10.1053/j.semvascsurg.2016.08.005
- Stirbu O, Gadalean F, Pitea IV, Ciobanu G, Schiller A, Grosu I, Nes A, Bratescu R, Olariu N, Timar B, Tandrau MC. C-reactive protein as a prognostic risk factor for loss of arteriovenous fistula patency in hemodialyzed patients. J Vasc Surg. 2019;70(1):208-15. DOI: https://doi.org/10.1016/j.jvs.2018.10.100
- Delgado-Ramírez A, Ruiz-García E, Latorre-López L, Crespo-Montero R. Factores que influyen en la supervivencia de la fístula arteriovenosa interna y su relación con la técnica de punción. Enferm Nefrol. 2016;19(3):215-30. DOI: https://doi.org/10.4321/S2254-28842016000300004
- Morton SK, Rodríguez AJ, Morris DR, Bhandari AP, Moxon JV, Golledge J. A Systematic Review and Meta-Analysis of Circulating Biomarkers Associated with Failure of Arteriovenous Fistulae for Haemodialysis. PLoS One. 2016;11(7) e0159963. DOI: https://doi.org/10.1371/journal.pone.0159963
- Siddiqui M, Ashraff S, Carline T. An overview of AVF maturation and endothelial dysfunction in a advanced renal failure. Renal Replacement Therapy. 2017;3:42. DOI: https://doi.org/10.1186/s41100-017-0123-x
- Martinez-Mier G, Camargo-Diaz C, Urbina-Velazquez MA, Avila-Pardo SF. Predictive Factors for Unsuccessful Use of Arteriovenous Fistula in a Population of End-Stage Renal Disease Patients in Southeastern Mexico. Ann Vasc Surg. 2020;62:304-9. DOI: https://doi.org/10.1016/j.avsg.2019.06.034
- Hu S, Wang D, Ma T, Yuan F, Zhang Y, Gao X, Lei Q, Cheng J. Association between Preoperative Monocyte-to-Lymphocyte Ratio and Late Arteriovenous Fistula Dysfunction in Hemodialysis Patients: A Cohort Study. Am J Nephrol. 2021;52(10-11):854-60. DOI: https://doi.org/10.1159/000519822
- Kaller R, Arbănași EM, Mureșan AV, Voidăzan S, Arbănași EM, Horváth E, Suciu BA, Hosu I, Halmaciu I, Brinzaniuc K, Russu E. The Predictive Value of Systemic Inflammatory Markers, the Prognostic Nutritional Index, and Measured Vessels' Diameters in Arteriovenous Fistula Maturation Failure. Life (Basel). 2022;12(9):1447. DOI: https://doi.org/10.3390/life12091447
- Eroglu E, Kocyiğit I, Karakukcu C, Tuncay A, Zararsiz G, Eren D, Kahriman G, Hayri Sipahioglu M, Tokgoz B, Tasdemir K, Oymak O. Hypoxia-inducible factors in arteriovenous fistula maturation: A prospective cohort study. Eur J Clin Invest. 2020;50(12):e013350. DOI: https://doi.org/10.1111/eci.13350
- Hu S, Wang R, Ma T, Lei Q, Yuan F, Zhang Y, Wang D, Cheng J. Association between preoperative C-reactive protein to albumin ratio and late arteriovenous fistula dysfunction in hemodialysis patients: a cohort study. Sci Rep. 2023;13(1):11184. DOI: https://doi.org/10.1038/s41598-023-38202-w
- Lok CE, Huber TS, Lee T, et al; KDOQI Vascular Access Guideline Work Group. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4)(suppl 2):S1-164. DOI: https://doi.org/10.1053/j.ajkd.2019.12.001
- Kaller R, Russu E, Arbănași EM, Mureșan AV, Jakab M, Ciucanu CC, et all. Intimal CD31-Positive Relative Surfaces Are Associated with Systemic Inflammatory Markers and Maturation of Arteriovenous Fistula in Dialysis Patients. J Clin Med. 2023;12(13):4419. DOI: https://doi.org/10.3390/jcm12134419
- Eroglu E, Kocyigit I, Kahriman G, Karakukcu C, Tuncay A, Zararsiz GE, Eren D, Kalay N, Sipahioglu MH, Oymak O, Tokgoz B. Soluble vascular endothelial growth factor receptor-1 as a novel marker of arteriovenous fistula stenosis in hemodialysis patients. Hemodial Int. 2021;25(2):164-72. DOI: https://doi.org/10.1111/hdi.12903
- Lobo JC, Stockler-Pinto MB, da Nóbrega AC, Carraro-Eduardo JC, Mafra D. Is there association between uric acid and inflammation in hemodialysis patients? Ren Fail. 2013;35(3):361-6. DOI: https://doi.org/10.3109/0886022X.2013.764274
- Brahmbhatt A, Misra S. The Biology of Hemodialysis Vascular Access Failure. Semin Intervent Radiol. 2016;33(1):15-20. DOI: https://doi.org/10.1055/s-0036-1572355
- Brunet P, Gondouin B, Duval-Sabatier A, Dou L, Cerini C, Dignat-George F, et all. Does uremia cause vascular dysfunction? Kidney Blood Press Res. 2011;34(4):284-90. DOI: https://doi.org/10.1159/000327131
- Caravaca F, Martín MV, Barroso S, Cancho B, Arrobas M, Luna E, et all. Niveles de ácido úrico y proteína C reactiva en pacientes con insuficiencia renal crónica. Nefrologia. 2005;25(6):645-54.
- Murea M, Tucker BM. The physiology of uric acid and the impact of end-stage kidney disease and dialysis. Semin Dial. 2019;32(1):47-57. DOI: https://doi.org/10.1111/sdi.12735
- Zhou Y, Fang L, Jiang L, Wen P, Cao H, He W, Dai C, Yang J. Uric acid induces renal inflammation via activating tubular NF-kB signaling pathway. PLoS One. 2012;7(6):e39738. DOI: https://doi.org/10.1371/journal.pone.0039738
- Roldão M, Figueiredo C, Escoli R, Gonçalves H, Sofia F, Lopes K. Vascular access type and mortality in elderly incident hemodialysis patients. Nefrologia. 2023;43(4):452-7. DOI: https://doi.org/10.1016/j.nefro.2022.02.007
- Khavanin Zadeh M, Mohammadipour S, Omrani Z. Correlation between CRP and early failure of arteriovenous fistula (AVF). Med J Islam Repub Iran. 2015;29:219.
- Okuhata Y, Sakai Y, Ikenouchi A, Kashiwagi T, Iwabu M. Low Serum Albumin Levels are Associated with Short-Term Recurrence of Arteriovenous Fistula Failure. J Nippon Med Sch. 2024;91(4):383-90. DOI: https://doi.org/10.1272/jnms.JNMS.2024_91-408
- Sadaghianloo N, Contenti J, Dardik A, Mazure NM. Role of Hypoxia and Metabolism in the Development of Neointimal Hyperplasia in Arteriovenous Fistulas. Int J Mol Sci. 2019;20(21):5387. DOI: https://doi.org/10.3390/ijms20215387
- Zhang Y, Kong X, Liang L, Xu D. Regulation of vascular remodeling by immune microenvironment after the establishment of autologous arteriovenous fistula in ESRD patients. Front Immunol. 2024;15:1365422. DOI: https://doi.org/10.3389/fimmu.2024.1365422
- Li C, Li Q, Ou J, Li W, Guan B, Lu Y, et al. Relationship between Monocytes and Stenosis-Related Autologous Arteriovenous Fistula Dysfunction. Blood Purif. 2022;51(3):226-32. DOI: https://doi.org/10.1159/000514059
Referencias
Brahmbhatt A, Remuzzi A, Franzoni M, Misra S. The molecular mechanisms of hemodialysis vascular access failure. Kidney Int. 2016;89(2):303-16. DOI: https://doi.org/10.1016/j.kint.2015.12.019
Duque JC, Martinez L, Tabbara M, Dvorquez D, Mehandru SK, Asif A, Vazquez-Padron RI, Salman LH. Arteriovenous fistula maturation in patients with permanent access created prior to or after hemodialysis initiation. J Vasc Access. 2017;18(3):185-91. DOI: https://doi.org/10.5301/jva.5000662
Gameiro J, Ibeas J. Factors affecting arteriovenous fistula dysfunction: A narrative review. J Vasc Access. 2020;21(2):134-47. DOI: https://doi.org/10.1177/1129729819845562
Ibeas J, Roca-Tey R, Vallespín J, Moreno T, Moñux G , Martí-Monrós A, et al. Guía clínica española del acceso vascular para hemodiálisis. Nefrología. 2017;37:1-177. DOI: https://doi.org/10.1016/j.nefro.2017.11.004
Siddiqui MA, Ashraff S, Carline T. Maturation of arteriovenous fistula: Analysis of key factors. Kidney Res Clin Pract. 2017;36(4):318-28. DOI: https://doi.org/10.23876/j.krcp.2017.36.4.318
Zhang F, Li J, Yu J, Jiang Y, Xiao H, Yang Y, Liang Y, Liu K, Luo X. Risk factors for arteriovenous fistula dysfunction in hemodialysis patients: a retrospective study. Sci Rep. 2023;13(1):21325. DOI: https://doi.org/10.1038/s41598-023-48691-4
Hu H, Patel S, Hanisch JJ, Santana JM, Hashimoto T, Bai H, Kudze T, Foster TR, Guo J, Yatsula B, Tsui J, Dardik A. Future research directions to improve fistula maturation and reduce access failure. Semin Vasc Surg. 2016;29(4):153-71. DOI: https://doi.org/10.1053/j.semvascsurg.2016.08.005
Stirbu O, Gadalean F, Pitea IV, Ciobanu G, Schiller A, Grosu I, Nes A, Bratescu R, Olariu N, Timar B, Tandrau MC. C-reactive protein as a prognostic risk factor for loss of arteriovenous fistula patency in hemodialyzed patients. J Vasc Surg. 2019;70(1):208-15. DOI: https://doi.org/10.1016/j.jvs.2018.10.100
Delgado-Ramírez A, Ruiz-García E, Latorre-López L, Crespo-Montero R. Factores que influyen en la supervivencia de la fístula arteriovenosa interna y su relación con la técnica de punción. Enferm Nefrol. 2016;19(3):215-30. DOI: https://doi.org/10.4321/S2254-28842016000300004
Morton SK, Rodríguez AJ, Morris DR, Bhandari AP, Moxon JV, Golledge J. A Systematic Review and Meta-Analysis of Circulating Biomarkers Associated with Failure of Arteriovenous Fistulae for Haemodialysis. PLoS One. 2016;11(7) e0159963. DOI: https://doi.org/10.1371/journal.pone.0159963
Siddiqui M, Ashraff S, Carline T. An overview of AVF maturation and endothelial dysfunction in a advanced renal failure. Renal Replacement Therapy. 2017;3:42. DOI: https://doi.org/10.1186/s41100-017-0123-x
Martinez-Mier G, Camargo-Diaz C, Urbina-Velazquez MA, Avila-Pardo SF. Predictive Factors for Unsuccessful Use of Arteriovenous Fistula in a Population of End-Stage Renal Disease Patients in Southeastern Mexico. Ann Vasc Surg. 2020;62:304-9. DOI: https://doi.org/10.1016/j.avsg.2019.06.034
Hu S, Wang D, Ma T, Yuan F, Zhang Y, Gao X, Lei Q, Cheng J. Association between Preoperative Monocyte-to-Lymphocyte Ratio and Late Arteriovenous Fistula Dysfunction in Hemodialysis Patients: A Cohort Study. Am J Nephrol. 2021;52(10-11):854-60. DOI: https://doi.org/10.1159/000519822
Kaller R, Arbănași EM, Mureșan AV, Voidăzan S, Arbănași EM, Horváth E, Suciu BA, Hosu I, Halmaciu I, Brinzaniuc K, Russu E. The Predictive Value of Systemic Inflammatory Markers, the Prognostic Nutritional Index, and Measured Vessels' Diameters in Arteriovenous Fistula Maturation Failure. Life (Basel). 2022;12(9):1447. DOI: https://doi.org/10.3390/life12091447
Eroglu E, Kocyiğit I, Karakukcu C, Tuncay A, Zararsiz G, Eren D, Kahriman G, Hayri Sipahioglu M, Tokgoz B, Tasdemir K, Oymak O. Hypoxia-inducible factors in arteriovenous fistula maturation: A prospective cohort study. Eur J Clin Invest. 2020;50(12):e013350. DOI: https://doi.org/10.1111/eci.13350
Hu S, Wang R, Ma T, Lei Q, Yuan F, Zhang Y, Wang D, Cheng J. Association between preoperative C-reactive protein to albumin ratio and late arteriovenous fistula dysfunction in hemodialysis patients: a cohort study. Sci Rep. 2023;13(1):11184. DOI: https://doi.org/10.1038/s41598-023-38202-w
Lok CE, Huber TS, Lee T, et al; KDOQI Vascular Access Guideline Work Group. KDOQI clinical practice guideline for vascular access: 2019 update. Am J Kidney Dis. 2020;75(4)(suppl 2):S1-164. DOI: https://doi.org/10.1053/j.ajkd.2019.12.001
Kaller R, Russu E, Arbănași EM, Mureșan AV, Jakab M, Ciucanu CC, et all. Intimal CD31-Positive Relative Surfaces Are Associated with Systemic Inflammatory Markers and Maturation of Arteriovenous Fistula in Dialysis Patients. J Clin Med. 2023;12(13):4419. DOI: https://doi.org/10.3390/jcm12134419
Eroglu E, Kocyigit I, Kahriman G, Karakukcu C, Tuncay A, Zararsiz GE, Eren D, Kalay N, Sipahioglu MH, Oymak O, Tokgoz B. Soluble vascular endothelial growth factor receptor-1 as a novel marker of arteriovenous fistula stenosis in hemodialysis patients. Hemodial Int. 2021;25(2):164-72. DOI: https://doi.org/10.1111/hdi.12903
Lobo JC, Stockler-Pinto MB, da Nóbrega AC, Carraro-Eduardo JC, Mafra D. Is there association between uric acid and inflammation in hemodialysis patients? Ren Fail. 2013;35(3):361-6. DOI: https://doi.org/10.3109/0886022X.2013.764274
Brahmbhatt A, Misra S. The Biology of Hemodialysis Vascular Access Failure. Semin Intervent Radiol. 2016;33(1):15-20. DOI: https://doi.org/10.1055/s-0036-1572355
Brunet P, Gondouin B, Duval-Sabatier A, Dou L, Cerini C, Dignat-George F, et all. Does uremia cause vascular dysfunction? Kidney Blood Press Res. 2011;34(4):284-90. DOI: https://doi.org/10.1159/000327131
Caravaca F, Martín MV, Barroso S, Cancho B, Arrobas M, Luna E, et all. Niveles de ácido úrico y proteína C reactiva en pacientes con insuficiencia renal crónica. Nefrologia. 2005;25(6):645-54.
Murea M, Tucker BM. The physiology of uric acid and the impact of end-stage kidney disease and dialysis. Semin Dial. 2019;32(1):47-57. DOI: https://doi.org/10.1111/sdi.12735
Zhou Y, Fang L, Jiang L, Wen P, Cao H, He W, Dai C, Yang J. Uric acid induces renal inflammation via activating tubular NF-kB signaling pathway. PLoS One. 2012;7(6):e39738. DOI: https://doi.org/10.1371/journal.pone.0039738
Roldão M, Figueiredo C, Escoli R, Gonçalves H, Sofia F, Lopes K. Vascular access type and mortality in elderly incident hemodialysis patients. Nefrologia. 2023;43(4):452-7. DOI: https://doi.org/10.1016/j.nefro.2022.02.007
Khavanin Zadeh M, Mohammadipour S, Omrani Z. Correlation between CRP and early failure of arteriovenous fistula (AVF). Med J Islam Repub Iran. 2015;29:219.
Okuhata Y, Sakai Y, Ikenouchi A, Kashiwagi T, Iwabu M. Low Serum Albumin Levels are Associated with Short-Term Recurrence of Arteriovenous Fistula Failure. J Nippon Med Sch. 2024;91(4):383-90. DOI: https://doi.org/10.1272/jnms.JNMS.2024_91-408
Sadaghianloo N, Contenti J, Dardik A, Mazure NM. Role of Hypoxia and Metabolism in the Development of Neointimal Hyperplasia in Arteriovenous Fistulas. Int J Mol Sci. 2019;20(21):5387. DOI: https://doi.org/10.3390/ijms20215387
Zhang Y, Kong X, Liang L, Xu D. Regulation of vascular remodeling by immune microenvironment after the establishment of autologous arteriovenous fistula in ESRD patients. Front Immunol. 2024;15:1365422. DOI: https://doi.org/10.3389/fimmu.2024.1365422
Li C, Li Q, Ou J, Li W, Guan B, Lu Y, et al. Relationship between Monocytes and Stenosis-Related Autologous Arteriovenous Fistula Dysfunction. Blood Purif. 2022;51(3):226-32. DOI: https://doi.org/10.1159/000514059