title: Impact of vascular calcifications on arteriovenous fistula survival in hemodialysis patients: a five-year follow-up.
abstract: OBJECTIVE
  Vascular calcifications are frequently found among dialysis patients, and the calcification process may influence the patient's outcome. The aim of the present study was to determine the role that vascular calcifications may have on autologous arteriovenous fistula (AVF) survival.
  
  
  METHODS
  This study included 90 patients (49 males, mean age 62 ± 11) with a native AVF treated by chronic hemodialysis (HD) for more than one year. The overall vascular calcification scores ranged from 0-11 (Adragao score + vascular access calcification score); patients were categorized into mild (score 0-3; n = 36), moderate (score 4-7; n = 24) and severe (score 8-11; n = 30) calcification groups. AVF survival was then followed for 5 years after calcification measurement or until the patient's death/transplantation.
  
  
  RESULTS
  Patients with more pronounced vascular calcifications were more frequently diabetic and male. Multiple linear regression analysis showed a significant relationship between calcification score and male gender, diabetes mellitus, previous duration of AVF, low dialysis flow rate and intact parathormone (iPTH) values. After multivariate adjustment for basal differences, Cox proportional analysis revealed a graded impact of calcification scores on AVF failure: moderate scores (were associated with a hazard rate (HR) of 3.82 (95% confidence interval (CI) 1.10-13.23) and severe scores with an HR of 4.65 (CI 0.97-22.38).
  
  
  CONCLUSIONS
  Vascular calcifications are associated with worse survival of native arteriovenous hemodialysis fistulas.
authors.affiliation: Clinical Department for Renal Diseases, Zvezdara University Medical Center, Belgrade, Serbia.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Jankovic
authors.forename: Tatjana
authors.initials: T
authors.lastname: Damjanovic
authors.forename: Zivka
authors.initials: Z
authors.lastname: Djuric
authors.forename: Jelena
authors.initials: J
authors.lastname: Marinkovic
authors.forename: Georg
authors.initials: G
authors.lastname: Schlieper
authors.forename: Jelena
authors.initials: J
authors.lastname: Tosic-Dragovic
authors.forename: Petar
authors.initials: P
authors.lastname: Djuric
authors.forename: Jovan
authors.initials: J
authors.lastname: Popovic
authors.forename: Juergen
authors.initials: J
authors.lastname: Floege
authors.forename: Nada
authors.initials: N
authors.lastname: Dimkovic
mesh_terms: D000368:Aged; D001164:Arteriovenous Fistula / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D006435:Renal Dialysis / Q000009:adverse effects; D061205:Vascular Calcification / Q000209:etiology* / Q000473:pathology