Analysis on factors relevant to operation success rate of internal arteriovenous fistula used in pediatric patients with end stage renal disease

Abstract

To analyze the factors relevant to success rate of arteriovenous fistula (AVF) plasty in children who need maintenance hemodialysis and to provide predictor of the success of operation. Totally 62 patients who had arteriovenous fistula plasty operation for maintenance of hemodialysis in our hospital treated during June 2007 to April 2014 were enrolled into this study, 41 were male, and 21 female, median age of surgery was 11 years and 9 months (age range was 5 y 8 m to 16 y 2 m). The proportions of primary diseases were: chronic glomerulonephritis 29% (18), kidney abnormality and dysplasia 27% (17). These 62 cases were divided into 2 groups: the success group and the failure group according to whether there were tremble and vascular murmur on the surgery site 1 week after the surgery. Factors like sex, choice of operation side, choice of operation vessel, anesthesia, urine protein, model of vascular suture line, age of surgery, inner diameter of anastomotic stoma, hemoglobin (Hb), platelet (Plt), hematocrit (Hct), coagulation function (prothrombin time, PT, fibrinogen, Fib, activated partial thromboplastin time, APTT), creatinine (Scr), Ca²⁺, left ventricular ejection fraction (LVEF), blood pressure (before, during and after surgery) were collected retrospectively. Student's t test and chi-square tests were used to analyze the differences of the factors between 2 groups. Those factors which were statistically significant in t test and chi-square test were taken into multi factor logistic regression analysis. (1) Average time interval from final diagnosis of ESRD to surgery was 30.8 days. (2) Relevant factors of operation success rate: anesthesia (χ² = 5.531, P=0.026), preoperative serum cholesterol (CHO) (t=-2.069, P=0.043), mean systolic blood pressure in the afternoon before operation (t=2.154, P=0.042), systolic blood pressure when the operation was finished (t=2.199, P=0.032) were related to the success rate of AVF operation in the t test and chi-square test. Multi factors logistic regression analysis showed systolic blood pressure measured when the operation was finished was a dependent protective factor of the surgery (OR=0.962, P=0.040, 95% CI=0.926-0.998). When the systolic blood pressure at the end of operation elevated 1 mmHg (1 mmHg=0.133 kPa), the failure rate of the surgery would be 0.962 times. The time interval from final diagnosis of ESRD to surgery was 30.8 days, it was much shorter than 6-12 months which was suggested by 2006 NKF-KDOQI vascular access guideline. As dependent protective factor of success rate, the systolic blood pressure at the end of operation was suggested to be the predictor of successful operation. And the higher systolic blood pressure at the end of operation may increase the success rate of operation.