Advertisement

Baseline plasma glycemic profiles but not inflammatory biomarkers predict symptomatic restenosis after angioplasty of arteriovenous fistulas in patients with hemodialysis

      Abstract

      Objective

      The aim of the study was to evaluate the role of atherosclerosis risk factors and baseline inflammatory status in the development of restenosis after successful percutaneous transluminal angioplasty (PTA) of hemodialysis arteriovenous (AV) fistulas.

      Research design and methods

      We obtained baseline plasma biochemistry and inflammatory markers in 140 patients with dysfunctional AV fistulas before the PTA procedures. Patients were followed clinically for 6 months.

      Results

      There was no significant difference in the baseline inflammatory markers between the restenosis and patency group. The Kaplan–Meier analysis showed that non-diabetic patients had higher patency rate than diabetic patients (69% vs. 48%, p = 0.02) and diabetic patients with optimal glycemic control had higher patency rate than patients with suboptimal glycemic control (61% vs. 30%, p = 0.01).

      Conclusions

      The presence of diabetes mellitus predicted restenosis of AV fistulas after PTA and optimal blood glucose control might be critical to the patency after PTA.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hakim R.
        • Himmelfarb J.
        Hemodialysis access failure: a call to action.
        Kidney Int. 1998; 54: 1029-1040
        • Roy-Chaudhury P.
        • Kelly B.S.
        • Melhem M.
        • et al.
        Vascular access in hemodialysis: issues, management, and emerging concepts.
        Cardiol Clin. 2005; 23: 249-273
        • Clark T.W.
        • Hirsch D.A.
        • Jindal K.J.
        • Veugelers P.J.
        • LeBlanc J.
        Outcome and prognostic factors of restenosis after percutaneous treatment of native hemodialysis fistulas.
        J Vasc Interv Radiol. 2002; 13: 51-59
        • Rajan D.K.
        • Bunston S.
        • Misra S.
        • Pinto R.
        • Lok C.E.
        Dysfunctional autogenous hemodialysis fistulas: outcomes after angioplasty—are there clinical predictors of patency?.
        Radiology. 2004; 232: 508-515
        • Wu C.C.
        • Wen S.C.
        • Yang C.W.
        • Pu S.Y.
        • Tsai K.C.
        • Chen J.W.
        Plasma ADMA predicts restenosis of arteriovenous fistula.
        J Am Soc Nephrol. 2009; 20: 213-222
        • Heine G.H.
        • Ulrich C.
        • Sester U.
        • Sester M.
        • Kohler H.
        • Girndt M.
        Transforming growth factor beta1 genotype polymorphisms determine AV fistula patency in hemodialysis patients.
        Kidney Int. 2003; 64: 1101-1107
      1. Standards of medical care in diabetes—2008.
        Diabetes Care. 2008; 31: S12-S54
        • Aronson D.
        • Bloomgarden Z.
        • Rayfield E.J.
        Potential mechanisms promoting restenosis in diabetic patients.
        J Am Coll Cardiol. 1996; 27: 528-535
        • Chen Y.H.
        • Lin S.J.
        • Lin F.Y.
        • et al.
        High glucose impairs early and late endothelial progenitor cells by modifying nitric oxide-related but not oxidative stress-mediated mechanisms.
        Diabetes. 2007; 56: 1559-1568
        • Kaysen G.A.
        The microinflammatory state in uremia: causes and potential consequences.
        J Am Soc Nephrol. 2001; 12: 1549-1557
        • Rectenwald J.E.
        • Moldawer L.L.
        • Huber T.S.
        • Seeger J.M.
        • Ozaki C.K.
        Direct evidence for cytokine involvement in neointimal hyperplasia.
        Circulation. 2000; 102: 1697-1702
        • De Marchi S.
        • Falleti E.
        • Giacomello R.
        • et al.
        Risk factors for vascular disease and arteriovenous fistula dysfunction in hemodialysis patients.
        J Am Soc Nephrol. 1996; 7: 1169-1177
        • Chang C.J.
        • Ko Y.S.
        • Ko P.J.
        • et al.
        Thrombosed arteriovenous fistula for hemodialysis access is characterized by a marked inflammatory activity.
        Kidney Int. 2005; 68: 1312-1319
        • Marrone D.
        • Pertosa G.
        • Simone S.
        • et al.
        Local activation of interleukin 6 signaling is associated with arteriovenous fistula stenosis in hemodialysis patients.
        Am J Kidney Dis. 2007; 49: 664-673
        • Dixon B.S.
        • Novak L.
        • Fangman J.
        Hemodialysis vascular access survival: upper-arm native arteriovenous fistula.
        Am J Kidney Dis. 2002; 39: 92-101