Abstract 625: Adipose-Associated Mediators Correlate with Anatomic and Physiologic Adaptations Following Fistula Placement: The Hemodialysis Fistula Maturation (HFM) Study

Abstract

Introduction: Perivascular inflammation stands as an important regulator of vascular remodeling. We hypothesize that the phenotype of adipose tissue adjacent to a hemodialysis arteriovenous fistula (AVF) modulates the anatomy and physiology of maturation. Methods: During AVF creation, adipose tissue adjacent to the vein was collected from 112 participants in the NIDDK HFM Study, and 9 adipose-associated mediator protein levels were measured. AVF duplex ultrasound was performed post-operatively at Day 1, and Weeks 2 and 6, and prior to 1 st cannulation (Week 10-22) to define the changes in diameter and flow. Associations between biomarker levels and fistula remodeling were evaluated using mixed effects regression analyses. Results: Fractional changes in vein diameter decrease with increasing IL-6 and MCP-1 levels; changes in AVF flow decrease with increasing leptin ( A ). IL-6 demonstrated a statistically significant relationship with vein adaptations in the early time frame (1D-2W), but not in the later stages of remodeling ( B ). Additional interaction effects between concentration and diameter/flow changes were identified, with elevated inflammatory biomarker levels correlated with reduced early and peri-anastomotic changes in vein diameter and flow ( C ). Conclusions: Changes in AVF diameter and flow are associated with baseline local adipose phenotype. Impaired vein dilation and reduced capacity for flow augmentation appears related to enhanced inflammation, particularly at early times and in the peri-anastomotic region.