title: Anthropometric parameters of nutritional assessment as predictive factors of arteriovenous fistula malfunction in patients undergoing hemodialysis.
abstract: BACKGROUND
  To evaluate the role of body mass index (BMI), waist circumference (W-C) and waist/hip ratio (WHR) on arteriovenous fistula (AVF) dysfunction.
  
  
  METHODS
  We evaluated 84 HD patients with an average follow-up period of 31.3 ± 8.1 months, identifying 8 stenosis (STN) and 17 thrombosis (THR) cases. The association between paired variables was tested with Pearson's coefficient (r) and p-value, whereas the prognostic value on STN and THR was analysed using Cox's regression. The significant independent variables were indentified with an inverse step-wise approach defining the data as hazard ratio (HR). A double-event (Stenosis/Thrombosis) model, function of Body mass index and Waist/hip ratio was used. Arteriovenous fistula survival was assessed with the Kaplan-Meyer curve and the calculations were carried out with Graph-Pad.
  
  
  RESULTS
  On univariate analysis, THR showed direct correlation with BMI (r=0.44, p<0.01), W-C (r=0.39, p<0.05) WHR (r=0.37, p<0.01), Hemoglobin (p<0.001), C-Reactive protein (p=0.01), Calcium/Phosforus product (p=0.03), Parathyroid hormone (p=0.03) and inverse with albumin (p<0.001) and systolic blood pressure (p=0.003). On multivariate analysis, BMI variations were not predictive of STN and THR, whereas each unitary WHR and W-C increase was predictive of an increase of risk of events (3.8% and 2.1% respectively). The prognostic power of W-C per STN (HR 1: 1.19; p<0.05) and THR (HR: 1.28; p<0.01) remained significant even after being adjusted to account for traditional risk factors.
  
  
  CONCLUSIONS
  Abdominal obesity increases the risk of AVF dysfunction. The W-C and WHR parameters, not BMI, emerge as independent STN and THR predictors.
authors.affiliation: Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Cosenza, Italy. gmgagliardi@libero.it
authors.forename: Gian Manlio
authors.initials: GM
authors.lastname: Gagliardi
authors.forename: Domenico
authors.initials: D
authors.lastname: Mancuso
authors.forename: Enrica
authors.initials: E
authors.lastname: Falbo
authors.forename: Francesco
authors.initials: F
authors.lastname: Mollica
authors.forename: Agata
authors.initials: A
authors.lastname: Mollica
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Barcellona
authors.forename: Massimo
authors.initials: M
authors.lastname: Senatore
authors.forename: Renzo
authors.initials: R
authors.lastname: Bonofiglio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000886:Anthropometry / Q000379:methods*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D015992:Body Mass Index; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009752:Nutritional Status; D056128:Obesity, Abdominal / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D055105:Waist Circumference; D049629:Waist-Hip Ratio
chemical_list: D015415:Biomarkers