대한신장학회

논문분류	춘계학술대회 초록집
제목	Predictive factors for fistula survival in an immature fistula group: a singlecenter study
저자	Chang HUN2, Hong jin BAE2, Young rok HAM2, Kang wook LEE2, Jiwon LEE1, Dae eun CHOI2, *Ki ryang NA2
출판정보	2017; 2017(1):
키워드	arteriovenous fistulas, hemodialysis, immature, intervention, angioplasty, risk factors
초록	Objectives : Successful maintenance of arteriovenous fistula (AVF) is an integral part in hemodialysis (HD) centers. An AVF failing to mature after operation is considered as ‘immature’ fistula, which usually requires angioplastic intervention. This study sought to determine predictive factors which affect the patency of immature fistulas after the initial intervention. Methods : We retrospectively reviewed the records and angiographic images of patients who had immature fistulas and thereby received angioplasty between years 2013 to 2016 at our center. Immaturity was defined as failure of HD initiation within 8 weeks post-operation. Fistula survival time was defined as intervention-free period after the initial angioplasty. There were 88 patients with immature fistula and 11 were excluded (9 deceased, 1 lost during follow-up, 1 received a kidney transplantation) to finally include 77 eligible patients. We used cox proportional hazard model to identify predictive factors for the fistula survival. Results : The median age at intervention of the 77 patients were 65.0 [38-87] years. There were 30 males and 47 females. The median fistula survival time was 360.0 [14-1569] days. Of the 77, 44 (57%) were intervention-free to date and 33 (43%) underwent additional angioplasty. Factors associated with fistula survival included age at intervention (P=0.018), type of AVF (either brachiocephalic(BC) or radiocephalic (RC), P=0.009), interval time since AVF operation (P =0.049), the angle of anastomosis (P=0.019), serum level of phosphorus and the diameter of the vein and artery at anastomosis (P =0.035 and P =0.008, respectively). After adjustment of competing risks, diameter of artery at the anastomosis site had statistically significant association with the fistula survival (B= -0.252, Exp(B)=0.777, 95% CI = 0.613- 0.985, P=0.037). In addition, we have grouped the patients into two groups according to the anastomosis site; BC and RC groups. The median fistula survival time was 251.0 days [15-1373] for the BC group (n=21) and 425.5 days [14-1569] for the RC group (n=56). In the BC group, none of the aforementioned factors showed statistical significance. In the RC group, after adjustment of competing risks, diameter of artery at the anastomosis site remained associated with fistula survival time (B= -0.510, Exp(B)=0.601, 95% CI = 0.399- 0.904, P=0.015). Conclusions : In this study, we have analyzed a cohort of patients with immature fistulas in an attempt to seek factors affecting AVF survival in this population. Patients with radiocephalic anastomosis showed superior outcome compared to brachiocephalic counterparts. Greater arterial diameter at the anastomosis site was associated with longer fistula survival time. Further studies in a larger scale are warranted to better elucidate and confirm the risks.
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