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Malnutrition, infection and arteriovenous fistula failure: Is there a link?
MedLine Citation:
PMID:  21038306     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Introduction: The histology of neointimal hyperplasia, the primary cause of arteriovenous fistula (AVF) stenosis, resembles the histology of atherosclerosis. We evaluated classic atherogenic risk factors such as hypertension, smoking, diabetes, cholesterol, and evaluated the role of expanded risk factors such as: cytomegalovirus (CMV), Helicobacter pylori (H. pylori), Chlamydia pneumoniae (C. pneumoniae), infection, and malnutrition, as possible causes of AVF failure in hemodialysis (HD) patients. Methods: AVF of 91 HD patients were monitored by on-line blood flow measurement (Qac); levels of albumin, fibrinogen, C-reactive protein and plasma cholesterol were recorded. Nutrition was evaluated via the Malnutrition Inflammation Score and the normalized protein intake (nPCR). Seropositivity to CMV, C. pneumoniae and H. Pylori were assessed. Results: Twenty-one patients had at least one episode of vascular access thrombosis; 17 patients had stenotic lesions. Analysis of survival tables revealed that patients who had high IgG CMV antibody levels had a higher probability of AVF failure than patients with lower CMV antibody levels. The difference in the empirical survival functions was statistically significant when we stratified by CMV antibody levels, unlike H. pylori or C. pneumoniae. In a logistic regression model, CMV, increased cholesterol, and decreases in nPCR and Qac significantly increased the risk of AVF failure. Conclusion: Our study suggests that CMV infection, total plasma cholesterol, decreased Qac, and nPCR are important risk factors of AVF failure in HD patients.
Authors:
Gian Manlio Gagliardi; Stefania Rossi; Francesca Condino; Domenico Mancuso; Francesca Greco; Robert Tenuta; Olga Savino; Renzo Bonofiglio; Filippo Domma; Giovanni Latorre
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of vascular access     Volume:  12     ISSN:  1724-6032     ISO Abbreviation:  J Vasc Access     Publication Date:    2011 Jan-Mar
Date Detail:
Created Date:  2011-03-01     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100940729     Medline TA:  J Vasc Access     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  57-62     Citation Subset:  IM    
Affiliation:
Division of Nephrology, Dialysis and Transplantation Unit, Annunziata Hospital, Cosenza - Italy.
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