Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis

Abstract

AIM:To determine survival parameters as well as characteristics of patients with this syndrome. METHODS:The investigation was conducted over a period of eight years, as a prospective, non-randomized, clinical study which included 204 patients, treated by chronic hemodialysis. Most patients received hemodialysis 12 h per week. As vascular access for hemodialysis all subjects had an arteriovenous fistulae. Based on surveys the respondents were divided into groups of patients with and without digital hypoperfusion ischemic syndrome. Gender, demographic and anthropometric characteristics, together with comorbidity and certain habits, were recorded. During this period 34.8% patients died. RESULTS:Patients with digital hypoperfusion ischemic syndrome were older than those without ischemia (P = 0.01). Hemodialysis treatment lasted significantly longer in the patients with digital hypoperfusion ischemic syndrome (P = 0.02). The incidence of cardiovascular disease (P < 0.001) and diabetes mellitus (P = 0.01), as well as blood flow through the arteriovenous fistula (P = 0.036), were higher in patients with digital hypoperfusion ischemic syndrome. Statistically significant differences also existed in relation to oxygen saturation (P = 0.04). Predictive parameters of survival for patients with digital hypoperfusion ischemic syndrome were: adequacy of hemodialysis (B = -3.604, P < 0.001), hypertension (B = -0.920, P = 0.018), smoking (B = -0.901, P = 0.049), diabetes mellitus (B = 1.227, P = 0.005), erythropoietin therapy (B = 1.274, P = 0.002) and hemodiafiltration (B = -1.242, P = 0.033). KaplanMeier survival analysis indicated that subjects with and without digital hypoperfusion ischemic syndrome differed regarding the length of survival (P < 0.001), i.e. , patients with confirmed digital hypoperfusion ischemic syndrome died earlier. CONCLUSION:Survival was significantly longer in the patients without digital hypoperfusion ischemic syndrome.© 2013 Baishideng. All rights reserved.Key words: Digital hypoperfusion ischemic syndrome; Predictive parameters; Survival; Arteriovenous fistula; Hemodialysis Core tip: In order to prevent the occurrence of distal hypoperfusion syndrome, is important identification of risk factors. Problem is the absence of objective indicators of distal ischemia, which is main reason why large proportion our patients have of this symptoms. Our patients with these symptoms were significantly older, which confirms older age as a factor that characterizes BRIEF ARTICLE 26May 6, 2013|Volume 2|Issue 2| WJN|www.wjgnet.com patients with distal hypoperfusion syndrome. We have confirmed greater incidence of diabetes mellitus and smokers among the patients with distal hypoperfusion syndrome. Quality of dialysis, diabetes mellitus, erythropoietin therapy, smokers and hemodiafiltration has predictive value for survival of patients with distal ischemia.Stolic RV, Trajkovic GZ, Miric DJ, Kisic B, Djordjevic Z, Azanjac GL, Stanojevic MS, Stolic DZ. Arteriovenous fistulas and digital hypoperfusion ischemic ...

Stenotic ligature: a simple technique for managing distal hypoperfusion ischemic syndrome following arteriovenous fistulas

“…Comorbidities such as diabetes (especially insulindependent), coronary artery disease and peripheral arteriopathy are all linked to accelerated atherosclerosis and subsequently are prone to developing ischemia symptoms when blood flow is altered as it is the case of an arteriovenous anastomosis (3,5,21). Our study confirmed coronary artery disease and arteriopathy as risk factors for developing DHIS.…”

“…Lazarides et al (19) retrospectively studied 69 patients with AVF and proved that in 94% of cases a degree of hypoperfusion syndrome exists distal to the fistula as differences in blood pressure were found between the arm bearing the fistula and the controlateral one. However, clinically manifest DHIS will develop only in 8% of patients as compensatory mechanisms (arterial collaterals and distal vasodilatation) improve tissue perfusion (3). Other studies have shown that a surgical procedure is necessary in 1,7% -9% of patients (20)(21)(22).…”

“…Previously DHIS was known as arterial theft syndrome however now it is clear that more factors stand at the basis of DHIS development. Besides true retrograde flow, peripheral arteriopathy and arterial stenosis proximal to the AVF are cumulative risk factors (2,3). Although the latter two cannot be surgically controlled, arterial theft can be diminished by different surgical approaches thus relieving distal ischemia.…”

Role of Myeloperoxidase in Patients with Chronic Kidney Disease

“…Moreover, in patients undergoing maintenance HD treatment the higher basal serum MPO was associated with inflammation, advanced atherosclerosis, and poorer prognosis [ 44 , 46 ]. On the other hand, basal serum MPO activity in HD patients was in several studies within the range of healthy controls [ 47 , 48 ], except in cases with arteriovenous fistula thrombosis [ 49 ]. These discrepant results probably reflect many confounding factors, such as the duration of HD treatment, use of different dialysis membranes/reuse of a dialyzer, different proportion of underlying causes of CKD, MPO genetic polymorphisms, comorbidities, vitamin, mineral, and antioxidant supplementation, and lipid lowering drugs.…”

Digital hypoperfusion ischemic syndrome in the patients with transposition of the basilic vein

“…Our experience with creation of arteriovenous fistulas for hemodialysis by transposition of veins, shows that there are still are many dilemmas and complications, which should be taken into consideration before deciding on this type of vascular access [6,7,8]. …”