P1367THE RELATIONSHIP OF SERUM PHOSPHORUS LEVEL AND ARTERIOVENOUS FISTULA DYSFUNCTION IN MAINTENANCE HEMODIALYSIS

Abstract

Abstract Background and Aims It is known that maintenance of function of arteriovenous fistula (AVF) is very important in the management of hemodialysis (HD) patients. Therefore, identifying a risk factor for decreased vascular access flow has a clinical relevance in real world practice. Although hyperphosphatemia plays a crucial role in the pathogenesis of vascular calcification, there is lack of studies evaluating the effect of hyperphosphatemia on AVF. This study investigated the impact of serum phosphorous (P) on vascular access flow in HD patients. Method Sixty-two maintenance HD patients who visited dialysis unit of Bundang CHA Medical Center from November 2016 to December 2017 were included in this study. Serum P levels were determined every month and time-averaged serum P was calculated. All patients had left arm AVF (side to side anastomosis) and vascular access flow was assessed by Transonic HD 03. Decreased vascular access flow was defined as less than 600 mL/min. Results The mean age was 57.9 ± 12.1 years, 32 patients (51.6%) were men. The mean serum P levels were 5.1 ± 1.1 mg/dL and the vascular access flow was 1,071.4 ± 504.2 mL/min. Decreased vascular access flow was observed in 14 of 62 patients (22.6%). In univariate analysis, higher serum P was significantly associated with decreased vascular access flow (odds ratio [OR]=2.089, 95% confidence interval [CI]=1.159-3.766, P=0.014). But there was no significant association of dialysis blood flow rate, ejection fraction on echocardiography and serum calcium (Ca) levels with vascular access flow. Multivariable analysis indicated that higher serum P was independently associated with greater risk of decreased vascular access flow (OR=4.012, 95% CI=1.651-9.711, P=0.002). Old age, reduced EF, low dialysis blood flow rate and higher serum Ca was not associated with vascular access flow. Conclusion This study demonstrated that higher serum P was the independent risk factor for decreased vascular access flow in maintenance HD patients. Serial monitoring of serum P may be helpful to stratify the risk of vascular access dysfunction in these patients.