FACTORS ASSOCIATED WITH ARTERIOVENOUS FISTULA FUNCTIONAL MATURATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Dr.Marwin Manoah Baylis; Dr.Arul Vijayakumar

Volume : VIII, Issue : III, March - 2019

FACTORS ASSOCIATED WITH ARTERIOVENOUS FISTULA FUNCTIONAL MATURATION IN PATIENTS WITH CHRONIC KIDNEY DISEASE

Dr. Marwin Manoah Baylis, Dr. Arul Vijayakumar

Abstract :

Introduction:With increasing numbers of patients diagnosed with CKD, arteriovenous fistula (AVF) maturation has become a major factor in improving both dialysis related outcomes and quality of life of those patients. Compared to other types of access it has been established that a functional AVF access is the least likely to be associated with thrombosis, infection , secondary interventions to maintain patency, hospital admissions and death.AIM:Study of demographic factors implicated in the function maturation of arteriovenous fistulas. Also, to explore any possible association between preoperative haematological investigations and functional maturation..METHODS:We performed a retrospective chart review of 115 patients with CKD, of which male were 95(82.6%) and female were 20(17.4%) who were referred to Cardiothoracic department in Tirunelveli Medical College Hospital for creation of vascular access for HD. We included patients with primary AVFs ; and excluded those who underwent secondary procedures. Results Overall AVF functional maturation rate inour study was 53.91% (62/115) and the failure was 46.09% (53/115). Female gender showed significant association with non maturation and lower the systolic and diastolic blood pressure , more the failure . Patients who had relatively lower haemoglobin levels showed better functional maturation rates . Blood vessel diameters , the lesser the risk of failure.Discussion:In our study functional maturation of AVF is considered as successful cannulation for atleast 1 complete hemodialysis session.Complications faced were thrombosis , postop edema , infection , steal phenomenon non maturation. Although male gender is more prone to smoking and vessel wall damage , the patency rate was better among the male gender the reason for this preponderance is not known.The effects of the artery size may be because (1) blood flow propotional to the fourth power of the arterial radius and (2) larger arteries exhibit greater vasorelaxant response there by accommodating greater blood flow during AVF maturation.We also found better functional maturation rates with lower haemoglobin. This might be explained by the up regulation of endothelial Nitric oxide synthase (eNOS) in the newly formed conduit, leading to increased production of Nitric oxide (NO) and hemeoxygenase–1(HO–1).No is associated with vasodilatation and decreased cellular proliferation , whereas HO–1 has been shown to inhibit proliferation of vascular smooth muscle cells , platelet aggregation and vasospasm.Conclusion Female gender and lower systolic and diastolic BP was found to be associated with functional nan –maturation and low haemoglobin levels and larger diameter vessels were all associated with successful functional maturation