Analysis of risk factors of dysfunction arteriovenous fistula in single-center maintenance hemodialysis patients

Abstract

Objective To analyze the risk factors of arteriovenous fistula embolism in patients of hemodialysis room. Methods Patients who underwent routine hemodialysis and were hospitalized in Huadu District People’s Hospital of Guangzhou from December 31st 2008 to December 31st 2017 were selected as research objects. Of them, 50 patients with autogenous arteriovenous fistula (AVF) embolism were selected as embolization group and 98 patients with normal internal fistula were selected as control group. The gender, age, primary disease, age of dialysis, the service life of internal fistula, ratio of dialysis ultrafiltration volume on dry body mass, mean arterial pressure (MAP) fluctuations (before hemodialysis to after hemodialysis, the data from the first three times of hemodialysis in embolization group were selected, and the synchronous data of control group were selected), residual urine volume of the two groups were retrospectively analyzed; white blood cell count (WBC), hemoglobin (HB), platelet count (PLT) embolism of embolization group and synchronous data of WBC, HB, PLT of control group were recorded and analyzed. Results There was no significant difference in age, gender, age of dialysis and puncture method of internal fistula between the two groups (P>0.05). MAP fluctuations, ratio of dialysis ultrafiltration volume on dry body mass and residual urine volume after the first dialysis before the embolization of embolization group were significantly different from those of control group (P 0.05). There was no significant difference in the WBC, HB and PLT levels between the two groups (P>0.05). The incidence of diabetic nephropathy was 28% (14/50) in embolization group, and it was 13.27% (13/98) in control group, the difference between the two groups was statistically significant (χ2=4.819, P=0.028). Conclusions Diabetic nephropathy is an independent risk factor of internal fistula dysfunction in the hemodialysis center of hospital. MAP fluctuations and ratio of dialysis ultrafiltration volume on dry body mass after the first dialysis before the embolization are independent risk factors of internal fistula dysfunction in hemodialysis center. Residual urine volume is the protective factor of internal fistula embolism. MAP fluctuations, ratio of dialysis ultrafiltration volume on dry body mass before embolization after the second and third dialysis, and levels of WBC, HB, PLT during embolization have no obvious correlation with internal fistula embolism. Key words: Hemodialysis; Diabetic nephropathy; Arteriovenous fistula; Ratio of dialysis ultrafiltration volume on dry weight ratio; Mean arterial pressure; Residual urine volume