TITLE: Impact of clinical parameters and vascular haemodynamics on arterio-venous fistula maturation in patients with end stage renal disease: A prospective study on Indian patients.
BACKGROUND: About 18%-65% of Arterio-Venous fistula (AVF) made to facilitate haemodialysis in end stage renal disease patient fail to mature. This study was designed to evaluate the impact of clinical parameters and vascular haemodynamics on maturation of AVF on Indian patients.
MATERIAL AND METHODS: This was a prospective observational study. Eligible patients' clinical profiles and vascular haemodynamics by Doppler ultrasonography were noted. All patients underwent radio-cephalic AVF on the non-dominant arm under local anaesthesia. Clinical definition was used to assess success rate of AVFs which is defined as successful six settings of satisfactory dialysis. Data were analysed using Stata/12.0 software. Independent t-test, chi-square test, logistic regression analysis and multivariate analysis were used. The p-value of <0.05 was considered significant.
RESULTS: A total of 205 patients were enrolled and analysed. Among clinical factors, age, sex, serum creatinine, hypertension had no significant association with failure (p = 0.5, 0.08, 0.76 and 0.74). Patient's BMI and presence of diabetes had significant impact on outcome (p < 0.001 and 0.02 respectively). Among vascular haemodynamics, radial vein diameter of >2.5 mm and radial artery flow rate >40 ml/min had no significant association with failure (p = 0.12 and 0.28). Diameter of radial artery (>2 mm) and intra-operatively immediate thrill were independent predictor of success (p = 0.002 and <0.001).
CONCLUSION: In the present study rate of fistula, maturation was 73.2% without any post-operative radiological intervention. Radial artery diameter >2 mm and presence of immediate thrill post-operatively were significantly associated with successful cannulation.
SOURCE: Ghosh NK, Bhattacharjee HK, Prajapati O, et al. Impact of clinical parameters and vascular haemodynamics on arterio-venous fistula maturation in patients with end stage renal disease: A prospective study on Indian patients[J]. J Vasc Access, 2021 :11297298211001158. DOI: 10.1177/11297298211001158.
背景：在晚期肾病患者中，约有18％-65％的动静脉内瘘（AVF）能够有助于血液透析，但仍未成熟。这项研究旨在评估印度患者临床参数和血管血流动力学对AVF成熟度的的影响。
材料与方法：这是一项前瞻性观察研究。记录了符合条件的患者的临床资料和通过多普勒超声检查获取血管血流动力学。所有患者均在局部麻醉下在非优势臂上接受了桡-头型AVF。临床评估AVF的成功率是采用令人满意透析的6法则。使用Stata/12.0软件分析数据。使用独立的t检验，卡方检验，逻辑回归分析和多元分析。 p值<0.05被认为是显着的。
结果：共纳入205例患者进行了分析。在临床因素中，年龄、性别、血肌酐、高血压与通路衰竭没有显着相关性（p = 0.5、0.08、0.76和0.74）。患者的BMI和糖尿病的存在对预后有显着影响（分别为p <0.001和0.02）。在血管血流动力学中，桡静脉直径> 2.5mm和桡动脉流量> 40ml / min与通路衰竭没有显着相关性（p = 0.12和0.28）。 桡动脉直径（> 2mm）和术中即刻震颤是成功的独立预测因素（p = 0.002和<0.001）。
结论：在目前的内瘘研究中，未进行任何干预的成熟率为73.2％。 桡动脉直径> 2mm以及术后立即出现震颤与成功穿刺显着相关。
启发：很多因素会影响内瘘的建立及成熟，内瘘的建立在基本原则下还是要个体化，特别是遇到哪些可能预后不好的，效果有时候比技术本身更重要！
