title: Thrombophilia and arteriovenous fistula survival in ESRD.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors: Coagulation Disorders, Department of Hematology, HUSLAB Laboratory Services, Helsinki University Central Hospital, Helsinki, Finland.
authors: Birgitta
authors: B
authors: Salmela
authors: Jari
authors: J
authors: Hartman
authors: Seija
authors: S
authors: Peltonen
authors: Anders
authors: A
authors: Albäck
authors: Riitta
authors: R
authors: Lassila
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D001777:Blood Coagulation / Q000235:genetics; D001780:Blood Coagulation Tests; D016009:Chi-Square Distribution; D004252:DNA Mutational Analysis; D048909:Diabetes Complications / Q000209:etiology; D005260:Female; D020022:Genetic Predisposition to Disease; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010641:Phenotype; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012307:Risk Factors; D012737:Sex Factors; D019851:Thrombophilia / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000235:genetics; D016896:Treatment Outcome; D014654:Vascular Patency; D055815:Young Adult