Endothelial function predicts positive arterial-venous fistula remodeling in subjects with stage IV and V chronic kidney disease.

Christopher D. Owens, Nicole Wake, Ji Min Kim, Dirk Hentschel, Michael S. Conte, Andres Schanzer

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

The maturation of an arteriovenous fistula (AVF) requires remodeling of the arterial inflow and the venous outflow limbs to sustain flows sufficient to support hemodialysis. However, factors influencing remodeling of AVF are poorly understood. We hypothesized that AVF remodeling was an endothelium-dependent process. This is a prospective cohort study of patients (n=25) undergoing autologous AVF formation. Brachial artery vasoreactivity studies were performed pre-operatively to assess endothelium-dependent, flow-mediated vasodilation (FMD). High-resolution ultrasound was used to assess venous and arterial diameters intraoperatively, and at 3 months. The mean age was 64.5 ± 13.6 yrs. Twelve patients (48%) had diabetes. The mean FMD for the entire cohort was (mean ± SEM) 5.82 ± 0.9%, (range) 0-17.3%. The vein increased in size 3.19 ± .28 to 6.11 ± .41 mm, 108.4 ± 17.9%, p=.0001, while the artery increased from 3.29 ± .14 to 4.48 ± .30 mm, 20.47 ± 10.8%, p=.013. There was a significant positive correlation between the degree of arterial and venous remodeling, r=.52, p=.023. Brachial artery FMD most strongly correlated with the magnitude of arterial remodeling, r=.47, p=.038. Patients with diabetes failed to undergo venous remodeling to the same extent as did those without diabetes, 59.2 ± 24.4% vs. 141.5 ± 25.4%, p=.04. Impairment of endothelial function is associated with decreased arterial remodeling and final venous lumen diameter attained at 3 months. Further investigation is needed to determine whether modulation of endothelial function in this cohort can improve AVF maturation.

Original languageEnglish (US)
Pages (from-to)329-334
Number of pages6
JournalThe journal of vascular access
Volume11
Issue number4
StatePublished - Oct 1 2010
Externally publishedYes

Fingerprint

Arteriovenous Fistula
Chronic Renal Insufficiency
Fistula
Vasodilation
Brachial Artery
Endothelium
Renal Dialysis
Veins
Cohort Studies
Extremities
Arteries
Prospective Studies

ASJC Scopus subject areas

  • Surgery
  • Nephrology

Cite this

Endothelial function predicts positive arterial-venous fistula remodeling in subjects with stage IV and V chronic kidney disease. / Owens, Christopher D.; Wake, Nicole; Kim, Ji Min; Hentschel, Dirk; Conte, Michael S.; Schanzer, Andres.

In: The journal of vascular access, Vol. 11, No. 4, 01.10.2010, p. 329-334.

Research output: Contribution to journalArticle

Owens, Christopher D. ; Wake, Nicole ; Kim, Ji Min ; Hentschel, Dirk ; Conte, Michael S. ; Schanzer, Andres. / Endothelial function predicts positive arterial-venous fistula remodeling in subjects with stage IV and V chronic kidney disease. In: The journal of vascular access. 2010 ; Vol. 11, No. 4. pp. 329-334.
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