The changes of high mobility group box protein-l in chronic renal failure hemodialysis patient with arteriovenous fistulas thrombosis

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Objective To investigate the changes of high mobility group box protein-l(HMGB-1) in chronic renal failure(CRF) patients with native arteriovenous fistulas (AVF) thrombosis, and to explore the relationship between inflammation and AVF thrombosis. Methods One hundred sixty CRF patients with AVF were divided into two groups according to whether with thrombosis after AVF operation: unobstructed group(n=132) and thrombosis group (n=28). The cases were collected from June, 2012 to July, 2015 in the second affiliated hospital of Nantong University. The comparative analysis of the level of triglyceride, total cholesterol, low density lipoprotein, urea nitrogen, serum creatinine, glucose, D-dimer, effects of erythropoietin was performed in two groups. The level of HMGB-1 was detected by ELISA. The levels of AVF preoperative HMGB-1 were detected in 160 cases of CRF patients. Before reopening, the levels of HMGB-1 in thrombosis group (n=28) were compared with the unobstructed group (n=56) which was in the same period. Analysis of HMGB-1 in the diagnosis of arteriovenous fistula thrombosis in the performance with the ROC curve. Results The triglyceride, total cholesterol, low density lipoprotein, urea nitrogen, serum creatinine, glucose, D-dimer, effects of erythropoietin had not been significant different between unobstructed group and thrombosis group (t=0.100, 0.740, 0.060, 0.350, 0.540, 1.050, 0.330, 0.080; P>0.05); In preoperative AVF, there was no difference between the levels of HMGB-1 in thrombosis group (n=28, 2.41±0.66 ng/ml) and unobstructed group (n=132, 2.53±0.64 ng/ml, t=0.90, P>0.05). Before recanalization, the levels of HMGB-1 in thrombosis group (n=28, 5.43±1.58 ng/ml) were significant higher than that of unobstructed group in the same period (n=56, 2.95±1.15 ng/ml, t=12.74, P<0.001). The levels of HMGB-1 in thrombosis group before reopening (n=28, 5.43±1.58 ng/ml) were increased when compared with before AVF (n=28, 2.41±0.66 ng/ml, t=9.33, P<0.001). Using the designated cut-off points≥4.175 ng/ml, the areas under the curves of HMGB-1 for prognosis was 0.840, 95% confidence interval was 0.736-0.944, the sensitivities and specificities were both 85.7%. Conclusions The inflammatory marker of HMGB-1 increased when AVF thrombosis, which also may be an active participant. It can be used as a predictor in the development of fistula thrombosis. Key words: High mobility group box protein-l; Native arteriovenous fistulas; Thrombosis