Study of Clinical and Biochemical Factors Affecting Early Failure of Arteriovenous Fistula in a Tertiary Care Hospital of Bangladesh

Author(s): Dr. Md. Shoriful Islam, Professor Dr. Md. Nizamuddin Chowdhury, Dr. Md. Saeed Hossain, Dr. Md. Safayet Hossain Pramanik, Dr. Md. Tamim Aziz, Dr. Md. Abdul Hakim

Background: Arteriovenous fistula is necessary for the maintenance of hemodialysis patients. Arteriovenous fistula patency is mandatory for adequate dialysis. However, early arteriovenous fistula failure is a substantial burden that influences the morbidity and mortality of maintenance hemodialysis patients. Clinical factors (BMI, BP, and DM) and biochemical factors (S. CRP, S. albumin, S. ferritin, fibrinogen, and NLR) are associated with early arteriovenous fistula failure. Aims of the study: To determine and explore the clinical and biochemical factors affecting early failure of arteriovenous fistula. Materials and methods: This observational study was conducted from January 2019 to July 2020 in the Department of Nephrology, Dhaka Medical College Hospital. Eighty-two patients with CKD stage 5 and ESRD were included in this study according to inclusion and exclusion criteria. Body mass index, blood pressure, serum hs C-reactive protein, serum albumin, serum ferritin, fibrinogen, and Neutrophil lymphocyte ratio were measured. After that, AVF construction was done. After AVF construction, participants were followed up weekly. During follow-up, a clinical examination (inspection, palpation, and auscultation) of AVF was performed to evaluate AVF status. AVF was grouped into AVF failure and AVF functioning. Data was analyzed by SPSS version 25. Results: The mean age of the patient was 47.13±13.48 years in the AVF failure group and 45.31±10.78 years in the AVF functioning group. High BMI (24.66 ±3.17 kg/m2) (P=0.002), DM (P=0.015), smoking (P=0.043), and diastolic blood pressure (63.7± 12.72 mm hg) (P=0.001) had a significant association with early AVF failure. Biochemical factors such as high hs CRP (36.5±27.03mg/l) (P=0.001), low albumin (28.04±7.05 g/l) (P=0.001) high ferritin (711.46±419.94 micg/l) (P=.001), high fibrinogen (507.47±178.45 mg/dl) and (P=0.001) NLR (6.36±2.31) (P=.001) were significantly associated with early AVF failure. However, no significant association was found between age and sex with early AVF failure. A multivariate logistic regression model found that BMI, smoking, DBP, hs CRP, and fibrinogen were independent predictors of early AVF failure. Conclusions: High body mass index, smoking, comparative low diastolic blood pressure, high hs C- reactive protein, and high fibrinogen were independent predictors of early arteriovenous fistula failure.