TITLE: The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients.

BACKGROUND: Arteriovenous fistulae (AVFs) may remain patent after kidney transplantation (KTx), contributing to maladaptive cardiac remodeling. The flow in AVFs is associated with the diameter of its vessels and thus with the AVF location. The main objective of this study is to assess the influence of AVF location and its patency on the self-reported quality of life (QOL) of kidney transplant recipients (KTRs) with past history of hemodialysis.

METHODS: To gain clinical data, during a scheduled visit, 353 KTRs were asked to fill out an anonymous questionnaire. From this group, 284 respondents were found eligible for analysis. The outcome was defined as prevalence of symptoms and health status, measured with the Left Ventricular Dysfunction-36 (LVD-36) Questionnaire in symptomatic patients.

RESULTS: The hemodialysis patients (n = 243) were divided into two groups according to AVF location, i.e., DAVF - distally located AVF - (n = 174) and PAVF - proximally located AVF - (n = 69). The proportion of patients with heart failure (HF) was higher in PAVF group (24% vs. 12%, p = 0.0482). In the multivariable regression, PAVF, serum creatinine levels, and the presence of HF or coronary artery disease (CAD) remained independent predictors of lower functional capacity. Among patients with heart disease, the presence of active AVF was independently associated with worse functional outcome (higher LVD-36 scores).

CONCLUSIONS: The influence of persistent PAVF in KTRs seems to be unfavorable, especially when coexisting with CAD or HF.

SOURCE: Letachowicz K, Bardowska K, Królicki T, et al. The impact of location and patency of the arteriovenous fistula on quality of life of kidney transplant recipients[J]. Ren Fail, 2021, 43(1):113-122. DOI: 10.1080/0886022X.2020.1865171. 

背景：动静脉内瘘（AVFs）可能在肾脏移植（KTx）后仍处于通畅状态，从而导致适应不良的心脏重塑。 AVF中的流量与其血管直径有关，并与其位置有关。这项研究的主要目的是评估AVF位置及其通畅性对过去有血液透析史的肾移植受者（KTR）自我报告生活质量（QOL）的影响。

方法：为了获得临床数据，在预定的就诊期间，要求353名KTR填写匿名问卷。从该组中，有284名受访者符合分析条件。结果定义为症状患者的症状和健康状况的发生率，采用左心室功能不全36（LVD-36）问卷进行测量。

结果：血液透析患者（n = 243）根据AVF位置分为两组，即DAVF【位于远端的AVF】（n = 174）和PAVF【位于近端的AVF】（n = 69）。 PAVF组的心力衰竭（HF）患者比例更高（24％ vs. 12％，p = 0.0482）。在多变量回归中，PAVF、血清肌酐水平以及心衰（HF）或冠状动脉疾病（CAD）的存在仍是功能降低的独立预测因素。在患有心脏病的患者中，活动性AVF的存在与功能恶化（LVD-36评分较高）独立相关。

结论：持久性PAVF对KTR的影响似乎是不利的，尤其是与CAD或HF共存时。

启发：内瘘的存在的确影响着心脏的重构，肾移植患者的AVF保留与否这一问题，需要反复斟酌，权衡利弊。