title: Calcification in arteriovenous fistula blood vessels may predict arteriovenous fistula failure: a 5-year follow-up study.
abstract: OBJECTIVE
  Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. The impact of vascular calcification process on AVF survival remains unclear and results of several studies about this issue are controversial. In the light of the new knowledge about the different susceptibility for calcification process in different blood vessels, the aim of our study was to analyze whether the calcification of AVF-blood vessels may have an impact on AVF longevity.
  
  
  METHODS
  The study included 90 patients, 49 males and 41 females, all of them Caucasians, with a mean age 62 ± 11 years, on regular hemodialysis for more than 1 year with patent primary AVFs. Vascular calcification in AVF-blood vessels or in the anastomotic region was detected using X-ray examination.
  
  
  RESULTS
  Calcification in AVF-blood vessels was found in 62% of patients. Binary logistic regression analysis demonstrated that male gender, presence of diabetes mellitus and longer duration of AVF before calcification determination were associated with calcification of AVF-blood vessels. Using a Cox proportional hazard model adjusted for these standardized predicted values revealed that patients with present AVF-blood vessels calcification had increased risk to develop AVF failure with a hazard rate of 3.42 (95% confidence interval 1.00-11.67; P = 0.049).
  
  
  CONCLUSIONS
  Calcifications of AVF-blood vessels are found frequently among dialysis patients and may jeopardize the survival of native AVF. We suggested the local X-ray as simple and valid method for detection of patients that are at risk for AVFs failure which should be monitored more closely.
authors.affiliation: Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000, Belgrade, Serbia. sashajan22@yahoo.com.
authors.forename: Aleksandar
authors.initials: A
authors.lastname: Jankovic
authors.affiliation: Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000, Belgrade, Serbia.
authors.forename: Tatjana
authors.initials: T
authors.lastname: Damjanovic
authors.affiliation: Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000, Belgrade, Serbia.
authors.forename: Zivka
authors.initials: Z
authors.lastname: Djuric
authors.affiliation: Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Jelena
authors.initials: J
authors.lastname: Marinkovic
authors.affiliation: Department of Nephrology and Clinical Immunology, Uniklinik RWTH Aachen, Aachen, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Schlieper
authors.affiliation: Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000, Belgrade, Serbia.
authors.forename: Petar
authors.initials: P
authors.lastname: Djuric
authors.affiliation: Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000, Belgrade, Serbia.
authors.forename: Jelena Tosic
authors.initials: JT
authors.lastname: Dragovic
authors.affiliation: Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000, Belgrade, Serbia.
authors.forename: Ana
authors.initials: A
authors.lastname: Bulatovic
authors.affiliation: Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000, Belgrade, Serbia.
authors.forename: Milos
authors.initials: M
authors.lastname: Mitrovic
authors.affiliation: Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000, Belgrade, Serbia.
authors.forename: Jovan
authors.initials: J
authors.lastname: Popovic
authors.affiliation: Department of Nephrology and Clinical Immunology, Uniklinik RWTH Aachen, Aachen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Floege
authors.affiliation: Clinical Department for Renal Diseases, Zvezdara University Medical Center, Dimitrija Tucovica 161, 11000, Belgrade, Serbia.|Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
authors.forename: Nada
authors.initials: N
authors.lastname: Dimkovic
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D017211:Treatment Failure; D061205:Vascular Calcification / Q000453:epidemiology* / Q000503:physiopathology*
keywords: AVF survival; AVF-blood vessels; Calcification; X-ray