1
|
Roumeliotis A, Vaios V, Girtovitis F, Karligkiotis A, Leivaditis K, Zebekakis P, Liakopoulos V. Thrombophilia in hemodialysis patients: Transfer to peritoneal dialysis is life saving. Semin Dial 2020; 33:338-342. [DOI: 10.1111/sdi.12877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Athanasios Roumeliotis
- Division of Nephrology and Hypertension 1st Department of Internal Medicine AHEPA University Hospital Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| | - Vasilios Vaios
- Division of Nephrology and Hypertension 1st Department of Internal Medicine AHEPA University Hospital Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| | | | - Apostolos Karligkiotis
- Division of Nephrology and Hypertension 1st Department of Internal Medicine AHEPA University Hospital Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| | - Konstantinos Leivaditis
- Division of Nephrology and Hypertension 1st Department of Internal Medicine AHEPA University Hospital Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| | - Pantelis Zebekakis
- Division of Nephrology and Hypertension 1st Department of Internal Medicine AHEPA University Hospital Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| | - Vassilios Liakopoulos
- Division of Nephrology and Hypertension 1st Department of Internal Medicine AHEPA University Hospital Medical School Aristotle University of Thessaloniki Thessaloniki Greece
| |
Collapse
|
2
|
Hasuike Y, Kakita N, Aichi M, Masachika S, Kantou M, Ikeda Takahashi S, Nanami M, Nagasawa Y, Kuragano T, Nakanishi T. Imbalance of coagulation and fibrinolysis can predict vascular access failure in patients on hemodialysis after vascular access intervention. J Vasc Surg 2019; 69:174-180.e2. [DOI: 10.1016/j.jvs.2018.04.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 04/07/2018] [Indexed: 01/15/2023]
|
3
|
Significant association of anti-platelet factor 4/heparin antibody with cardiovascular disease in hemodialysis patients: a longitudinal 7-year study. Int Urol Nephrol 2018; 50:2289-2297. [PMID: 30324576 DOI: 10.1007/s11255-018-2002-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Hemodialysis patients have a high incidence of anti-platelet factor 4/heparin antibody (PF4-H Ab) and are at a high risk of cardiovascular disease. This study determines the association between PF4-H Ab and cardiovascular events including coronary artery disease (CAD), ischemic stroke (IS), and native arteriovenous fistula thrombosis (AVFT), in a longitudinal 7-year follow-up. PATIENTS AND METHODS 84 hemodialysis patients were enrolled. Data collection included chart reviews and assessments of laboratory records. PF4-H Ab was evaluated by ELISA and a titer ≥ 0.4 was defined to have PF4-H Ab. RESULTS 30 patients were PF4-H Ab positive, 30 patients had CAD, 29 patients had IS, and 43 patients had AVFT. In Cox proportional hazard regression analysis, PF4-H Ab (HR 2.72, p = 0.01) was a significant risk factor for CAD. Age (HR 1.06, p = 0.003), PF4-H Ab (HR 4.53, p < 0.001), 7-year averaged serum phosphate levels (HR 0.53, p = 0.012), and 7-year averaged blood platelet count (HR 1.01, p = 0.029) were risk factors for IS. Age (HR 1.03, p = 0.047), PF4-H Ab (HR 3.57, p < 0.001), and 7-year averaged serum triglyceride levels (HR 1.01, p = 0.005) were risk factors for AVFT. In PF4-H Ab-positive groups, thrombocytopenia was not associated with CAD, IS, and AVFT by Fisher's test analysis. CONCLUSION This study reveals that PF4-H Ab is a risk factor for developing CAD, IS, and AVFT among hemodialysis patients.
Collapse
|
4
|
Endovascular Biopsy and Endothelial Cell Gene Expression Analysis of Dialysis Arteriovenous Fistulas: A Feasibility Study. J Vasc Interv Radiol 2018; 29:1403-1409.e2. [PMID: 30174159 DOI: 10.1016/j.jvir.2018.04.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 04/10/2018] [Accepted: 04/22/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE To demonstrate feasibility of endothelial cell (EC) biopsy from dialysis arteriovenous fistulas (AVFs) with the use of guidewires and to characterize gene expression differences between ECs from stenotic and nonstenotic outflow vein segments. MATERIALS AND METHODS Nine consecutive patients undergoing fistulography for AVF dysfunction from June to August 2016 were enrolled. ECs were biopsied with the use of guidewires from venous outflow stenoses and control outflow veins central to the stenoses. ECs were sorted with the use of flow cytometry, and the Fluidigm Biomark HD system was used for single-cell quantitative polymerase chain reaction (qPCR) analysis of gene expression. Forty-eight genes were assessed and were selected based on different cellular functions and previous literature. Linear mixed models (LMMs) were used to identify differential gene expression between the groups, and self-organizing maps (SOMs) were used to identify cell clusters based on gene coexpression profiles. RESULTS A total of 219 and 213 ECs were sampled from venous outflow stenoses and control vein segments, respectively. There were no immediate biopsy-related complications. Forty-eight cells per patient were sorted for qPCR analysis. LMM identified 7 genes with different levels of expression at stenotic segments (P < .05), including AGTR-2, HMOX-2, MTHFR, SERPINC-1, SERPINE-1, SMAD-4, and VWF. SOM analysis identified 4 cell clusters with unique gene expression profiles, each containing stenotic and control ECs. CONCLUSIONS EC biopsy from dialysis AVFs with the use of guidewires is feasible. Gene expression data suggest that genes involved in multiple cellular functions are dysregulated in stenotic areas. SOMs identified 4 unique clusters of cells, indicating EC phenotypic heterogeneity in outflow veins.
Collapse
|
5
|
Chen CF, Lin CC. The association of genotype polymorphisms with vascular access patency in hemodialysis patients. J Vasc Access 2018; 20:24-30. [PMID: 29512407 DOI: 10.1177/1129729818758556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Some hemodialysis patients suffer from repeat dysfunction of dialysis vascular access and need procedures of angioplasty, thrombectomy, and even temporary catheter use. Why these patients are vulnerable to vascular access dysfunction and how to improve its patency are imperative to be discovered. Traditional risk factors for vascular access function had been widely investigated but could not fully explain this question. Several genotype polymorphisms were demonstrated to increase the incidence of cardiovascular disease and might also be linked to higher risk of vascular access dysfunction. As the major causes of arteriovenous access thrombosis are hypercoagulable status and arteriovenous access stenosis, the investigated genes mainly focus on the mediators of the coagulation cascade, inflammatory process, and endothelial dysfunction. The reported polymorphisms of genes significantly associated with arteriovenous access dysfunction included genes encoding methylene tetrahydrofolate reductase, coagulation factors, heme oxygenase-1, matrix metalloproteinase, transforming growth factor-β1, tumor necrosis factor-α, vascular endothelial growth factor-A, renin-angiotensin-aldosterone system, and protein methyl transferase. However, further prospective study is indispensable to elucidate the association between the genotype polymorphisms and the outcome of vascular access. More and more therapeutic options that focus on genotype polymorphisms may generate a great benefit to the patency of vascular access of uremic patients.
Collapse
Affiliation(s)
- Chun-Fan Chen
- 1 School of Medicine, National Yang-Ming University, Taipei, Taiwan.,2 National Yang-Ming University Hospital, Yilan, Taiwan
| | - Chih-Ching Lin
- 1 School of Medicine, National Yang-Ming University, Taipei, Taiwan.,3 Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
6
|
Yeh EL, Huang YC, Tsai SF, Yu TM, Wu MJ, Chen CH. Relationship between plasma levels of homocysteine and the related B vitamins in patients with hemodialysis adequacy or inadequacy. Nutrition 2018; 53:103-108. [PMID: 29674265 DOI: 10.1016/j.nut.2018.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/28/2018] [Accepted: 02/01/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Hemodialysis (HD) with dialysis adequacy could increase the excretion of B vitamins (folate, vitamin B6, and B12) and raise the plasma level of homocysteine. Here we determined the associations of plasma homocysteine with B vitamins in patients with HD adequacy or inadequacy. METHODS We recruited 68 patients who had received HD treatments (three times a week, 4 h each). Based on the individual's hemogram and quarterly urea reduction rate (Kt/V), patients were pooled into one of the following two groups: the first group with dialysis adequacy (Kt/V > 1.2, n = 48) and the second with dialysis inadequacy (Kt/V ≤ 1.2, n = 20). We also recorded the anthropometric date of each patient and their biochemical data and dietary intakes. Plasma levels of homocysteine, cysteine, folate, pyridoxal 5'-phosphate (PLP), and vitamin B12 were measured twice, once before and once after HD. RESULTS The plasma levels of homocysteine, cysteine, folate, PLP, and vitamin B12 dropped significantly at the end of HD. The plasma levels of vitamin B12 were negatively correlated with the plasma levels of homocysteine, both pre- and post-HD, and in both groups regardless of dialysis adequacy or inadequacy. In contrast, plasma levels of folate and PLP were not correlated with homocysteine at both pre- or post-HD in both groups. CONCLUSIONS The plasma level of vitamin B12, but not folate or vitamin B6, was negatively correlated with that of homocysteine both before and after HD treatment, and regardless of dialysis adequacy or inadequacy.
Collapse
Affiliation(s)
- En-Ling Yeh
- Graduate Program in Nutrition, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Chia Huang
- Department of Nutrition, Chung Shan Medical University, Taichung, Taiwan; Department of Nutrition, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shang-Feng Tsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Tong-Min Yu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Division of Basic Medical Sciences, Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
| |
Collapse
|
7
|
Al-Jaishi AA, Liu AR, Lok CE, Zhang JC, Moist LM. Complications of the Arteriovenous Fistula: A Systematic Review. J Am Soc Nephrol 2016; 28:1839-1850. [PMID: 28031406 DOI: 10.1681/asn.2016040412] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 11/25/2016] [Indexed: 11/03/2022] Open
Abstract
The implementation of patient-centered care requires an individualized approach to hemodialysis vascular access, on the basis of each patient's unique balance of risks and benefits. This systematic review aimed to summarize current literature on fistula risks, including rates of complications, to assist with patient-centered decision making. We searched Medline from 2000 to 2014 for English-language studies with prospectively captured data on ≥100 fistulas. We assessed study quality and extracted data on study design, patient characteristics, and outcomes. After screening 2292 citations, 43 articles met our inclusion criteria (61 unique cohorts; n>11,374 fistulas). Median complication rates per 1000 patient days were as follows: 0.04 aneurysms (14 unique cohorts; n=1827 fistulas), 0.11 infections (16 cohorts; n>6439 fistulas), 0.05 steal events (15 cohorts; n>2543 fistulas), 0.24 thrombotic events (26 cohorts; n=4232 fistulas), and 0.03 venous hypertensive events (1 cohort; n=350 fistulas). Risk of bias was high in many studies and event rates were variable, thus we could not present pooled results. Studies generally did not report variables associated with fistula complications, patient comorbidities, vessel characteristics, surgeon experience, or nursing cannulation skill. Overall, we found marked variability in complication rates, partly due to poor quality studies, significant heterogeneity of study populations, and inconsistent definitions. There is an urgent need to standardize reporting of methods and definitions of vascular access complications in future clinical studies to better inform patient and provider decision making.
Collapse
Affiliation(s)
- Ahmed A Al-Jaishi
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Aiden R Liu
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
| | - Charmaine E Lok
- Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Joyce C Zhang
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada.,Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
| | - Louise M Moist
- The Lilibeth Caberto Kidney Clinical Research Unit, London Health Sciences Centre, London, Ontario, Canada; .,Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; and
| |
Collapse
|
8
|
Florou E, Koukoulaki M, Theodoros T, Kalatzis V, Vougas V, Stamataki E, Kokkinou VC, Kostakis A, Drakopoulos S. Successful Living-Related Renal Allograft in a Recipient With Factor V Leiden Deficiency: A Case Report. EXP CLIN TRANSPLANT 2015; 15:96-99. [PMID: 26102090 DOI: 10.6002/ect.2014.0255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Thrombophilia due to activated protein C resistance (Leiden mutation) is the most common inherited thrombophilic disorder with 5% incidence in whites. Renal transplant of these patients entails a risk of vascular thrombosis soon after the transplant; and acute rejection episodes and graft loss within the first year. We present a case of a successful living-related renal transplant in man with a recent history of repeat episodes of vascular access thrombosis attributed to inherited thrombophilia (heterozygosity for factor V mutation Q506 and homozygosity for mutation T677 for methylene-tetrahydrofolate reductase). Transplant recipient was administered anticoagulation therapy with low molecular weight heparin pre- and postoperatively. No thrombotic or hemorrhagic events occurred posttransplant. A high suspicion of thrombophilic disorders in patients with end-stage renal disease with vascular access thrombotic events should be screened further to prevent failure of a subsequent renal transplant. Inherited thrombophilic disorders may not exclude living-related kidney transplant provided that anticoagulation therapy is admin-istered perioperatively.
Collapse
Affiliation(s)
- Evangelia Florou
- From the First Department of Surgery Transplant Unit, Evangelismos General Hospital of Athens, Greece
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Soluble adhesion molecules as markers of native arteriovenous fistula thrombosis in children on uremia. Blood Coagul Fibrinolysis 2015; 25:675-82. [PMID: 24806324 DOI: 10.1097/mbc.0000000000000125] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Vascular access represents a lifeline for children undergoing hemodialysis. A failure of vascular access among patients receiving regular hemodialysis is associated with increased morbidity, mortality and costs. We assessed the possibility of using soluble adhesion molecules as reliable predictors of vascular access failure in children on hemodialysis. Moreover, we evaluated whether there is an association among the different studied adhesion molecules in hemodialysis patients with thrombosed and non-thrombosed arteriovenous fistula fistulas (AVFs). This study included 55 hemodialysis children, 36 with good access and 19 with access failure, and 20 healthy volunteers. Forty-four patients had native AVFs and 11 patients had tunneled permanent catheter (11with thrombosed and 33 with non-thrombosed AVFs). Serum-soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular adhesion molecule-1 (sICAM-1), soluble E-selectin (sE-selectin) and soluble P-selectin (sP-selectin) were measured using ELISA technique. A significant increase was found in the levels of sVCAM-1, sICAM-1, sE-selectin and sP-selectin versus controls and all hemodialysis patients, hemodialysis patients with good access and hemodialysis patients with access failure (P=0.001 for sVCAM-1 and sICAM-1 and P=0.0001 for sE-selectin and sP-selectin). A significant increase was found in the levels of sVCAM-1, sE-selectin and sP-selectin in both chronic hemodialysis patients with thrombosed and non-thrombosed native AVFs versus controls (P=0.0001 for all parameters). There was significant difference between both chronic hemodialysis patients with thrombosed and non-thrombosed native AVFs as regard to sVCAM-1 (54.64±30.82 versus 25.69±27.96ng/ml, P=0.04). Both sICAM-1 and sP-selectin were positively correlated with the erythropoietin (EPO) dose in hemodialysis children (r=0.31, P=0.04 and r=0.32, P=0.04, respectively). A significant positive association was found between E-selectin and sP-selectin in hemodialysis patients with thrombosed AVFs (r=0.83, P=0.04). There was a significant correlation between sVCAM-1 and EPO dose in thrombosed AVF group (r=0.84, P=0.01). The assessment of serum sVCAM-1 might be useful for the identification of the chronic hemodialysis patients at an increased risk for native AVFs thrombosis. The role of EPO in vascular access failure should be taken into consideration. The clinical relevance of these observations warrants further investigations.
Collapse
|
10
|
Nweke C, Martin E, Gehr T, Brophy D, Carl D. Differences in coagulation in clotting of vascular access in hemodialysis patients. Hemodial Int 2014; 19:323-9. [PMID: 25413181 DOI: 10.1111/hdi.12241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Arteriovenous graft (AVG) thrombosis is a frequent cause of graft failure. We evaluated coagulation protein concentrations, platelet function, and viscoelasticity factors in 20 hemodialysis (HD) patients with AVGs. The goal was to determine whether significant differences in protein concentrations, platelet function, and viscoelasticity factors exist among dialysis patients requiring frequent AVG declot procedures vs. those who do not. Twenty HD patients were enrolled: 10 frequent clotters (>3 declots in the previous year) and 10 were nonclotters. Patients on antiplatelets or chronic anticoagulation were excluded. Laboratories were drawn pretreatment and heparinase was added to counteract any potential heparin effect. Coagulation protein concentrations including tissue factor (TF), thrombin/antithrombin III complex (TAT), and prothrombin fragment 1 + 2 (F(1+2)) were assayed. The time to clot onset was measured by force onset time (FOT). Platelet contractile force (PCF) measured the force produced by platelets during clot retraction, whereas clot rigidity was measured as clot elastic modulus (CEM). FOT, CEM, and PCF were measured by Hemodyne. Both groups had upregulation of the TF pathway, as TF, TAT, and F(1+2) levels were similarly increased over baseline levels. Hemodialysis patients with frequent AVG clotting had higher levels of both PCF and CEM compared with nonclotters. Additionally, the frequent clotters had a lower FOT relative to nonclotters, although both were considered in the normal range. Our study suggests that HD patients with recurrent AVG thrombotic events form clots with higher tensile strength compared with HD patients without recurrent graft thrombosis.
Collapse
Affiliation(s)
- Chinedu Nweke
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | | | | | | |
Collapse
|
11
|
Saifan C, El-Charabaty E, El-Sayegh S. Hyperhomocysteinemia and vascular access thrombosis in hemodialysis patients: a retrospective study. Vasc Health Risk Manag 2013; 9:361-4. [PMID: 23898227 PMCID: PMC3718836 DOI: 10.2147/vhrm.s47255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Elevated total plasma homocysteine is an independent risk factor for arterial and venous thrombosis in patients with normal renal function. Patients on hemodialysis have a high prevalence of mild to moderate hyperhomocysteinemia. Conflicting retrospective analyses and prospective studies have been reported regarding the association between total homocysteine levels and hemodialysis vascular thrombosis. The purpose of this retrospective study was to investigate the relationship between hyperhomocysteinemia and vascular access thrombosis (VAT) in patients on hemodialysis. METHODS One hundred and twenty-five patients undergoing dialysis were selected as subjects. The experimental group participants were identified as those having one or more VAT during the previous 13 months and the control group participants had no access thrombosis during the same period. Additional subgroup analysis included the presence of hypertension, diabetes, low-density lipoprotein levels, sex, and use of aspirin. RESULTS No statistically significant difference was found in total homocysteine levels between the two groups (P = 0.27). No association was found between VAT and sex (P = 0.09), VAT and hypertension (P = 0.96), VAT and diabetes (P = 0.49), nor VAT and low-density lipoprotein level (P = 0.04). A lower rate of VAT was associated with aspirin intake (P = 0.04). CONCLUSION This study did not demonstrate a relationship between total homocysteine concentrations and risk of VAT in patients with end-stage renal disease on hemodialysis. There were no significant differences in the number of VAT across additional variables of sex and previous morbidity. Aspirin intake was associated with a lower incidence of VAT.
Collapse
Affiliation(s)
- Chadi Saifan
- Staten Island University Hospital, Staten Island, NY 10305, USA.
| | | | | |
Collapse
|
12
|
Salmela B, Hartman J, Peltonen S, Albäck A, Lassila R. Thrombophilia and arteriovenous fistula survival in ESRD. Clin J Am Soc Nephrol 2013; 8:962-8. [PMID: 23411429 DOI: 10.2215/cjn.03860412] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES The role of thrombophilia in failing arteriovenous fistula (AVF) among patients with ESRD undergoing hemodialysis is not established. This study aimed to assess whether AVF primary patency is associated with thrombophilia and coagulation abnormalities. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This observational study screened 219 patients between 2002 and 2004 for thrombophilia before AVF surgery. Thrombophilia included factor V Leiden and prothrombin G20210A mutations, protein C and antithrombin activities, and protein S. Coagulation abnormalities included high factor VIII:C, homocysteine, fibrinogen, and d-dimer levels; presence of antiphospholipid antibodies; and short thrombin time. We reviewed patient charts for comorbid conditions, AVF maturation and interventions, kidney transplantation, and patient survival (mean follow-up duration, 3.6 [range, 2.3-5.8] years). Primary patency from the AVF placement and functional primary patency from the first AVF cannulation were analyzed with Kaplan-Meier and Cox proportional hazards models. RESULTS Thrombophilia was present in 9% of the patients, and coagulation abnormalities occurred in 77%. One-year primary patency was 68%; 46% of the AVF failures occurred before the initiation of hemodialysis. Female sex (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.7-4.1) and thrombophilia (HR, 2.2; 95% CI, 1.2-4.2) were independent risk factors for loss of primary patency. Thrombophilia mutations or low antithrombin level (HR, 3.8), female sex (HR, 2.5), and diabetes (HR, 1.9) were associated with shortened functional primary patency of AVF. CONCLUSIONS Against the background of frequent coagulation abnormalities, thrombophilia and female sex predispose patients with ESRD to access failure, mostly due to thrombosis or stenosis.
Collapse
Affiliation(s)
- Birgitta Salmela
- Coagulation Disorders, Department of Hematology, HUSLAB Laboratory Services, Helsinki University Central Hospital, Helsinki, Finland
| | | | | | | | | |
Collapse
|
13
|
Anti-PF4/heparin antibodies are associated with arteriovenous fistula thrombosis in non-diabetic hemodialysis patients. Clin Exp Nephrol 2011; 16:300-5. [DOI: 10.1007/s10157-011-0555-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 10/14/2011] [Indexed: 10/16/2022]
|
14
|
Tripepi G, Mattace-Raso F, Sijbrands E, Witteman J, Rapisarda F, Malatino L, Mallamaci F, Zoccali C. Aging and Left Ventricular Mass and Function in People with End-Stage Renal Disease. J Am Geriatr Soc 2011; 59:1636-41. [DOI: 10.1111/j.1532-5415.2011.03564.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
15
|
Rios DRA, Carvalho MDG, Lwaleed BA, Simões e Silva AC, Borges KBG, Dusse LMS. Hemostatic changes in patients with end stage renal disease undergoing hemodialysis. Clin Chim Acta 2010; 411:135-9. [DOI: 10.1016/j.cca.2009.11.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2009] [Revised: 11/06/2009] [Accepted: 11/20/2009] [Indexed: 12/31/2022]
|
16
|
Estimation of Predictive Factors Affecting Patency of Dialysis Arteriovenous Fistulae. POLISH JOURNAL OF SURGERY 2010. [DOI: 10.2478/v10035-010-0020-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
17
|
Tripepi G, Mattace-Raso F, Mallamaci F, Benedetto FA, Witteman J, Malatino L, Zoccali C. Biomarkers of Left Atrial Volume. Hypertension 2009; 54:818-24. [DOI: 10.1161/hypertensionaha.109.136804] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Giovanni Tripepi
- From the Consiglio Nazionale delle Ricerche (CNR) and Institute of Bio-Medicine (IBIM) (G.T., F.M., C.Z.), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy; Departments of Geriatric and Internal Medicine and Epidemiology (F.M.-R., J.W.), Erasmus Medical Center, Rotterdam, the Netherlands; Cardiology Service (F.A.B.), Morelli Hospital, Reggio Calabria, Italy; and Department of Medicine (L.M.), University of Catania, Italy
| | - Francesco Mattace-Raso
- From the Consiglio Nazionale delle Ricerche (CNR) and Institute of Bio-Medicine (IBIM) (G.T., F.M., C.Z.), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy; Departments of Geriatric and Internal Medicine and Epidemiology (F.M.-R., J.W.), Erasmus Medical Center, Rotterdam, the Netherlands; Cardiology Service (F.A.B.), Morelli Hospital, Reggio Calabria, Italy; and Department of Medicine (L.M.), University of Catania, Italy
| | - Francesca Mallamaci
- From the Consiglio Nazionale delle Ricerche (CNR) and Institute of Bio-Medicine (IBIM) (G.T., F.M., C.Z.), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy; Departments of Geriatric and Internal Medicine and Epidemiology (F.M.-R., J.W.), Erasmus Medical Center, Rotterdam, the Netherlands; Cardiology Service (F.A.B.), Morelli Hospital, Reggio Calabria, Italy; and Department of Medicine (L.M.), University of Catania, Italy
| | - Francesco Antonio Benedetto
- From the Consiglio Nazionale delle Ricerche (CNR) and Institute of Bio-Medicine (IBIM) (G.T., F.M., C.Z.), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy; Departments of Geriatric and Internal Medicine and Epidemiology (F.M.-R., J.W.), Erasmus Medical Center, Rotterdam, the Netherlands; Cardiology Service (F.A.B.), Morelli Hospital, Reggio Calabria, Italy; and Department of Medicine (L.M.), University of Catania, Italy
| | - Jacqueline Witteman
- From the Consiglio Nazionale delle Ricerche (CNR) and Institute of Bio-Medicine (IBIM) (G.T., F.M., C.Z.), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy; Departments of Geriatric and Internal Medicine and Epidemiology (F.M.-R., J.W.), Erasmus Medical Center, Rotterdam, the Netherlands; Cardiology Service (F.A.B.), Morelli Hospital, Reggio Calabria, Italy; and Department of Medicine (L.M.), University of Catania, Italy
| | - Lorenzo Malatino
- From the Consiglio Nazionale delle Ricerche (CNR) and Institute of Bio-Medicine (IBIM) (G.T., F.M., C.Z.), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy; Departments of Geriatric and Internal Medicine and Epidemiology (F.M.-R., J.W.), Erasmus Medical Center, Rotterdam, the Netherlands; Cardiology Service (F.A.B.), Morelli Hospital, Reggio Calabria, Italy; and Department of Medicine (L.M.), University of Catania, Italy
| | - Carmine Zoccali
- From the Consiglio Nazionale delle Ricerche (CNR) and Institute of Bio-Medicine (IBIM) (G.T., F.M., C.Z.), Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, Reggio Calabria, Italy; Departments of Geriatric and Internal Medicine and Epidemiology (F.M.-R., J.W.), Erasmus Medical Center, Rotterdam, the Netherlands; Cardiology Service (F.A.B.), Morelli Hospital, Reggio Calabria, Italy; and Department of Medicine (L.M.), University of Catania, Italy
| |
Collapse
|
18
|
BROPHY DF, BUKAVECKAS BL, FERREIRA-GONZALEZ A, ARCHER KJ, MARTIN EJ, GEHR TW. A pilot study of genetic polymorphisms and hemodialysis vascular access thrombosis. Hemodial Int 2009; 13:19-26. [DOI: 10.1111/j.1542-4758.2009.00334.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Righetti M, Ferrario G, Serbelloni P, Milani S, Tommasi A. Some old drugs improve late primary patency rate of native arteriovenous fistulas in hemodialysis patients. Ann Vasc Surg 2008; 23:491-7. [PMID: 18973987 DOI: 10.1016/j.avsg.2008.08.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Revised: 06/19/2008] [Accepted: 08/13/2008] [Indexed: 11/26/2022]
Abstract
Vascular access failure causes 20% of all hospitalizations of dialysis patients. Native arteriovenous fistulas, the best type of dialysis vascular access, have a 1-year primary patency rate that is extremely variable, ranging 40-80%. Neointimal hyperplasia is the most important cause of arteriovenous fistula late primary dysfunction. In recent years the arteriovenous fistula late primary patency rate has not improved because of the increase of old uremic patients with a high number of comorbidities and the lack of new therapeutic interventions. Therefore, we performed a long-term case-control study to analyze which factors or drugs may affect native arteriovenous fistula late primary patency rate in 60 incident hemodialysis patients. The arteriovenous fistula late primary patency rate was 75.1% after 12 months, 58.5% after 24 months, and 50% after 987 days. Homocysteine levels during follow-up had a significant direct association with vascular access failure (event vs. event-free 28.5+/-1.9 vs. 22.3+/-1.2 micromol/L, p<0.01). Folate values had a trend toward an inverse relationship with arteriovenous fistula failure (event vs. event-free 11.5+/-1.2 vs. 14.6 vs. 1.1 ng/mL, p=0.06). Patients treated with folic acid and/or statin had an arteriovenous fistula late primary patency rate significantly higher than patients without folic acid and statin therapy, respectively, 81.7% vs. 66% after 1 year and 71.5% vs. 39.1% after 2 years (p=0.02). Many other factors were not associated with vascular access failure. Statin and homocysteine-lowering folic acid therapy is associated with prolonged arteriovenous fistula survival. It is important to perform randomized trials to verify our observation.
Collapse
Affiliation(s)
- Marco Righetti
- Nephrology and Dialysis Unit, Vimercate Hospital, Vimercate 20059, Italy.
| | | | | | | | | |
Collapse
|
20
|
Zohny SF, Abd El-Fattah M. Evaluation of circulating vascular endothelial growth factor and soluble adhesion molecules as reliable predictors of native arteriovenous fistula thrombosis in chronic hemodialysis patients. Clin Biochem 2008; 41:1175-80. [DOI: 10.1016/j.clinbiochem.2008.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Revised: 07/07/2008] [Accepted: 07/10/2008] [Indexed: 12/31/2022]
|
21
|
Cianciolo G, La Manna G, Colì L, Donati G, D'Addio F, Persici E, Comai G, Wratten M, Dormi A, Mantovani V, Grossi G, Stefoni S. 5-methyltetrahydrofolate administration is associated with prolonged survival and reduced inflammation in ESRD patients. Am J Nephrol 2008; 28:941-8. [PMID: 18587236 DOI: 10.1159/000142363] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 05/15/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hemodialysis (HD) patients have a greatly increased risk of cardiovascular morbidity and mortality. For this reason, attempts are often made to normalize hyperhomocysteinemia. This randomized prospective study sought to determine which risk factors are predictors of mortality and whether high doses of folates or 5-methyltetrahydrofolate (5-MTHF) could improve hyperhomocysteinemia and survival in HD patients. METHODS 341 patients were divided into two groups: group A was treated with 50 mg i.v. 5-MTHF, and group B was treated with 5 mg/day oral folic acid. Both groups received i.v. vitamin B(6) and B(12). By dividing patients into C-reactive protein (CRP) quartiles, group A had the highest survival for CRP <12 mg/l, whereas no survival difference was found for group B. CRP was the only predictive risk factor for death (RR 1.17, range 1.04-1.30, p = 0.02). Dialysis age, hyperhomocysteinemia, methylenetetrahydrofolate reductase polymorphism, albumin, lipoprotein (a) and folate did not influence mortality risk. Survival in group A was higher than that in group B, namely 36.2 +/- 20.9 vs. 26.1 +/- 22.2 months (p = 0.003). RESULTS Our results suggest that CRP, but not hyperhomocysteinemia, is the main risk factor for mortality in HD patients receiving vitamin supplements. Intravenous 5-MTHF seems to improve survival in HD patients independent from homocysteine lowering.
Collapse
Affiliation(s)
- Giuseppe Cianciolo
- Nephrology Dialysis and Renal Transplantation Unit, S.Orsola University Hospital, University of Bologna, Bologna, Italy
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Thrombophilias and arteriovenous fistula dysfunction in maintenance hemodialysis. J Thromb Thrombolysis 2008; 27:307-15. [DOI: 10.1007/s11239-008-0216-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2007] [Accepted: 03/17/2008] [Indexed: 10/22/2022]
|
23
|
Urquhart BL, Freeman DJ, Cutler MJ, Mainra R, Spence JD, House AA. Mesna for treatment of hyperhomocysteinemia in hemodialysis patients: a placebo-controlled, double-blind, randomized trial. Clin J Am Soc Nephrol 2008; 3:1041-7. [PMID: 18337551 DOI: 10.2215/cjn.04771107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Increased plasma total homocysteine is a graded, independent risk factor for the development of atherosclerosis and thrombosis. More than 90% of patients with end-stage renal disease have hyperhomocysteinemia despite vitamin supplementation. It was shown in previous studies that a single intravenous dose of mesna 5 mg/kg caused a drop in plasma total homocysteine that was significantly lower than predialysis levels 2 d after dosing. It was hypothesized 5 mg/kg intravenous mesna administered thrice weekly, before dialysis, for 8 wk would cause a significant decrease in plasma total homocysteine compared with placebo. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Patients with end-stage renal disease were randomly assigned to receive either intravenous mesna 5 mg/kg or placebo thrice weekly before dialysis. Predialysis plasma total homocysteine concentrations at weeks 4 and 8 were compared between groups by paired t test. RESULTS Mean total homocysteine at 8 wk in the placebo group was 24.9 micromol/L compared with 24.3 micromol/L in the mesna group (n = 22 [11 pairs]; mean difference 0.63). Interim analysis at 4 wk also showed no significant difference between mesna and placebo (n = 32 [16 pairs]; placebo 26.3 micromol/L, mesna 24.5 micromol/L; mean difference 1.88). Multivariable adjustments for baseline characteristics did not alter the analysis. Plasma mesna seemed to reach steady-state concentrations by 4 wk. CONCLUSIONS It is concluded that 5 mg/kg mesna does not lower plasma total homocysteine in hemodialysis patients and that larger dosages may be required.
Collapse
Affiliation(s)
- Bradley L Urquhart
- Department of Physiology and Pharmacology, University of Western Ontario, London Health Sciences Centre, London, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
24
|
Zoccali C, Mallamaci F, Tripepi G. CARDIOVASCULAR AND SURVIVAL PARADOXES IN DIALYSIS PATIENTS: It Is Important to Lower Homocysteine in Dialysis Patients. Semin Dial 2007; 20:530-3. [DOI: 10.1111/j.1525-139x.2007.00345.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
25
|
Suliman ME, Lindholm B, Bárány P, Qureshi AR, Stenvinkel P. CARDIOVASCULAR AND SURVIVAL PARADOXES IN DIALYSIS PATIENTS: Homocysteine-Lowering Is Not a Primary Target for Cardiovascular Disease Prevention in Chronic Kidney Disease Patients. Semin Dial 2007; 20:523-9. [DOI: 10.1111/j.1525-139x.2007.00336.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
26
|
Abstract
Complications of the vascular access site for hemodialysis are a major cause of morbidity, suboptimal dialysis, and hospitalization. Vascular access for dialysis that is achieved by central venous catheters is associated with complications such as infection and thrombosis. Arteriovenous fistulas and grafts are also at risk for infectious complications. Further, proliferation of the venous wall with secondary thrombosis is a common pathophysiological process that leads to vascular access dysfunction. Genetic polymorphisms that contribute to vascular access failure are found among factors of the coagulation cascade, and host mediators that induce endothelial dysfunction as well as vessel wall proliferation. The two most common mutations of coagulation factors seem to influence the risk of central venous catheter and fistula thrombosis. Indeed, both the single nucleotide polymorphism of the factor V gene at amino acid position 506 (factor V Leiden mutation) and the prothrombin 20210 polymorphism have been associated with thrombotic complications of the vascular access. Among the endothelium-directed factors, a polymorphism of the methylene tetrahydrofolate reductase gene coding for an enzyme that degrades the endothelium toxic product homocysteine, has been associated with fistula failure. While the angiotensin converting enzyme polymorphism does not seem to be associated with vascular access complications, polymorphisms of the profibrogenic cytokine transforming growth factor-beta1 are associated with the prognosis of native arteriovenous fistulae. The role of pro- and anti-inflammatory cytokine gene polymorphisms as prognostic factors for vascular access is yet to be clearly defined.
Collapse
Affiliation(s)
- Matthias Girndt
- Medical Department IV, University of the Saarland, Homburg/Saar, Germany.
| | | | | | | |
Collapse
|
27
|
Abstract
Vascular access thrombosis in the hemodialysis patient leads to significant cost and morbidity. Fistula patency supersedes graft patency, therefore obtaining a mature functioning fistula in patients approaching end-stage renal disease (ESRD) by early patient education and referral needs to be practiced. Current methods to maintain vascular access patency rely on early detection and radiologic or surgical prevention of thrombosis. Study of thrombosis biology has elucidated other potential targets for the prophylaxis of vascular access thrombosis. The goal of this review is to examine the current available methods for vascular access thrombosis prophylaxis.
Collapse
Affiliation(s)
- Devasmita Choudhury
- Department of Medicine, University of Texas Southwestern Medical School, VA North Texas Health Care System, Dallas, Texas 75216, USA.
| |
Collapse
|
28
|
Abstract
AbstractThe clinical management of individuals with hereditary hypercoaguable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism to a more intricate individualized risk-benefit analysis as studies have begun to delineate the complexity of interactions of acquired and hereditary factors which determine the predilection to thrombosis. The contribution of thrombophilic disorders to risk of thrombotic complications of pregnancy, organ transplantation, central venous catheter and dialysis access placement have been increasingly recognized. The risk of thrombosis must be weighed against risk of long-term anticoagulation in patients with venous thromboembolism. Thrombophilia screening in select populations may enhance outcome.
Collapse
|
29
|
Mallamaci F, Tripepi G, Zoccali C. In Reply. Am J Kidney Dis 2005. [DOI: 10.1053/j.ajkd.2005.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
30
|
Tai HC, Yang WC, Chen TW, Lin CC. Are Homocysteine and MTHFR Genotype Polymorphism Associated with Arteriovenous Fistula Patency? Am J Kidney Dis 2005; 46:993-4; author reply 994. [PMID: 16253747 DOI: 10.1053/j.ajkd.2005.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Accepted: 08/24/2005] [Indexed: 11/11/2022]
|