title: The clinicopathological determinants of native arteriovenous fistula failure in patients on maintenance hemodialysis.
abstract: BACKGROUND
  Progressive narrowing of the venous part of dialysis fistulae is caused by hemodynamic and inflammatory factors.
  
  
  OBJECTIVE
  The pathogenic and clinical determinants of deterioration of the functioning of arteriovenous fistulae in chronically hemodialyzed patients were evaluated.
  
  
  METHODS
  The hemodynamic parameters and the activity of inflammatory growth factors in the vessel wall of newly implanted fistulae were assessed and correlated with the clinical course of 34 hemodialyzed patients. Measurements taken at the time of implanting the fistulae included blood flow in the venous part of the anastomosis and its widest diameter by ultrasound Power Doppler, a histopathologic examination of fistula wall samples and measurements of mRNA expression for growth factors PDGFβ1 and TGFβ in the fistula wall. The results were correlated with clinical data from 36 months' observation: duration of fistula maturation, adequacy of dialysis treatment (eKt/V), the patient's survival, morbidity linked with vascular access problems and general cardiovascular morbidity.
  
  
  RESULTS
  The mean duration of fistula maturation was 44.9 days (N = 43, SD = 38.6), whereas the average duration of fistula usage as dialysis access was 795.9 ± 480.6 days. Fistula blood flow at the time of implantation, averaged 1782.2 ± 1735.3 ml/min. The mean number of hospitalization days due to vascular access morbidity was 9.9 ± 15.6 days and it correlated positively with the fistula blood flow (R = 0.596, P = 0.004). There was a negative correlation between the expression of PDGFβ1 mRNA and fistula blood flow (R = -0.673, P = 0.011), as well as between TGFβ expression and patient survival (R = -0.722, P = 0.002).
  
  
  CONCLUSIONS
  Inflammatory activity of the vessel wall growth factors PDGFβ1 and TGFβ implies impairment of fistula function and the patient's cardiovascular morbidity.
authors.affiliation: Department of Nephrology, Regional Specialist Hospital Center for Research & Development, Wrocław, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Hruby
authors.forename: Maria
authors.initials: M
authors.lastname: Stanek-Piotrowska
authors.forename: Jakub
authors.initials: J
authors.lastname: Turek
authors.forename: Wojciech
authors.initials: W
authors.lastname: Witkiewicz
authors.forename: Anna
authors.initials: A
authors.lastname: Jonkisz
authors.forename: Andrzej
authors.initials: A
authors.lastname: Konieczny
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kosiński
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Dobosz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006439:Hemodynamics; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D020574:Proto-Oncogene Proteins c-sis / Q000235:genetics; D012333:RNA, Messenger / Q000032:analysis; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D016212:Transforming Growth Factor beta / Q000235:genetics; D017211:Treatment Failure; D018616:Ultrasonography, Doppler, Duplex; D034941:Upper Extremity / Q000098:blood supply*; D014680:Veins / Q000737:chemistry / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D018836:Inflammation Mediators; D020574:Proto-Oncogene Proteins c-sis; D012333:RNA, Messenger; D016212:Transforming Growth Factor beta