Serum levels of the endothelial glycocalyx constituents and the early failure of forearm autologous arteriovenous fistulas in end-stage renal disease patients: a prospective cohort study.

Abstract

The relationship between the endothelial glycocalyx constituents and the early failure of autologous arteriovenous fistulas (AVFs) in ESRD patients is still unknown. In this prospective cohort study, 181 ESRD patients (the mean age was 53.3 ± 11.8years, 66.3% of them were males) received forearm AVFs surgery were consecutively enrolled with a median follow-up time of 10months. The early AVF failure was defined as a fistula that never developed adequately for dialysis use or that failed within the first 3months of use. The serum levels of glycocalyx constituents including glypicans-1 (GPC-1), syndecans-1 (SDC-1), and hyaluronan (HA), and the indicator of endothelial activation reflected by E-selectin (ES) were determined by ELISAs. The primary patencies of AVFs were 98.3%, 96.7%, 91.7%, and 89.5% at 3, 6, 12, and 18months, respectively. The ROC curve was plotted and demonstrated that HA, not GPC-1, SDC-1 or ES, can diagnose the AVF failure, with the cut-off value of 6.37ng/ml, the sensitivity of 87.5%, the specificity of 46.9%, and the Youden index of 0.34, respectively. The Kaplan-Meier survival analysis demonstrated that patients with HA < 6.37ng/mL had better patency of AVFs than patients with HA ≥ 6.37ng/mL (log-rank test, p = 0.008). In the Cox proportional hazards analysis, after adjusting for confounders, HA (≥ 6.37ng/mL vs. < 6.37ng/mL) was associated with the early AVFs failure, with the OR of 5.88 (1.21-28.60). This study demonstrated that HA can predict the early failure of forearm AVFs, when its serum level is more than 6.37ng/mL.