Hyperphosphatemia is associated with patency loss of arteriovenous fistula after 1 year of hemodialysis.
BACKGROUND
The patency of arteriovenous access is important for stable and effective hemodialysis, and long-term technical survival is best achieved with a native arteriovenous fistula (AVF). However, maintaining AVF patency remains a challenge. This study was designed to determine the independent prognostic factors for AVF patency according to hemodialysis duration.


METHODS
The primary study end point was unassisted patency of the AVF, which was defined as the time from the first fistula surgery to the first AVF failure. AVF failure was defined as an event that required percutaneous intervention or surgery to revise or replace the fistula, which occurred at least 2 months after fistula formation.


RESULTS
We enrolled 478 patients with a mean age of 55.5±14.0 years, and mean duration of dialysis was 2.5±2.1 years. There were 109 cases (22.8%) of AVF failure. The factors related to AVF patency differed according to hemodialysis duration. Using a Cox-adjusted model, we observed a significant correlation between the incidence of AVF failure and diabetes within the initial 12 months of hemodialysis. Uncontrolled hyperphosphatemia (mean serum phosphorus>5.5 mg/dL during hemodialysis) was associated with patency loss of AVF after 1 year of hemodialysis.


CONCLUSIONS
Various factors were associated with the development of patency loss of AVF as hemodialysis duration differed, and a preventive role of hyperphosphatemia control in AVF survival needs further clinical study.
Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
Ju-Young
JY
Moon
Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
Hyae Min
HM
Lee
Division of Nephrology, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea.
Sang-Ho
SH
Lee
Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea.
Tae-Won
TW
Lee
Division of Nephrology, Department of Internal Medicine, Kyung Hee University, Seoul, Korea.
Chun-Gyoo
CG
Ihm
Division of Nephrology, Department of Internal Medicine, Konkuk University, Seoul, Korea.
Young-Il
YI
Jo
Division of Nephrology, Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Korea.
Sang-Woong
SW
Han
Division of Nephrology, Department of Internal Medicine, NHIC Ilsan Hospital, Goyang, Korea.
Sug-Gyun
SG
Shin
Arteriovenous fistula; Hemodialysis; Hyperphosphatemia