Association Between Pulse Wave Velocity and Arteriovenous Fistula Stenosis in Hemodialysis Patients.

Abstract

Introduction: Arteriovenous (AV) fistulas are widely used in hemodialysis patients, but their most common complication is stenosis. Stiffness at the arterial site of the AV fistula is believed to contribute to stenosis. This study examines whether arterial stiffness can predict the development of AV fistula stenosis.

Methods: Arterial stiffness was assessed using brachial-ankle pulse wave velocity (PWV). Chart reviews and laboratory records were analyzed. The diagnosis and intervention for AV fistula stenosis were performed using fistulography and percutaneous transluminal angioplasty.

Findings: A total of 80 patients were enrolled in the study. Over the 7-year follow-up period, 40 patients developed AV fistula stenosis. Univariate logistic regression analysis revealed that AV fistula stenosis was significantly associated with diabetes (OR: 4.68, 95% CI: 1.19-18.34, p = 0.03), average monthly cholesterol level (OR: 1.02, 95% CI: 1.00-1.04, p = 0.03), average monthly triglyceride level (OR: 1.01, 95% CI: 1.00-1.01, p = 0.02), and brachial-ankle PWV (OR: 1.61, 95% CI: 1.32-1.97, p < 0.01). In multivariate logistic regression analysis, only brachial-ankle PWV remained significantly associated with AV fistula stenosis (OR: 1.72, 95% CI: 1.34-2.22, p < 0.01). Receiver-operating characteristic curve analysis identified 16.75 m/s as the optimal cutoff value of brachial-ankle PWV for predicting the development of AV fistula stenosis. Patients with PWV > 16.75 m/s had a significantly higher risk of developing AV fistula stenosis compared with those with a PWV ≤ 16.75 m/s (HR: 4.71, 95% CI: 2.22-9.97, p < 0.01).

Discussion: Assessment of brachial-ankle PWV can improve the prediction efficacy of AV fistula stenosis development in hemodialysis patients.