Calcium phosphate product level as a predictor for arteriovenous fistula re-operations in patients with chronic renal failure

Abstract

Objectives There is an increased calcium phosphate product level causing the formation of calcification in the arterial wall and thus decreased quality of fistula in patients with chronic renal failure. The purpose of our study is to verify the relationship between arteriovenous fistula re-operation and high calcium phosphate product level. Methods Seventy-nine consecutive patients with chronic renal failure between April 2016 and February 2018 were included in the study. Patients having calcium phosphate product level ≥50 mg2/dl2 were defined as group 1, whereas those having <50 mg2/dl2 were defined as group 2. Primary outcome of interest was the need for re-operation during the follow-up and to determine the risk factors for re-operation. To determine independent predictors for re-operation, multivariate logistic regression model was used. Results The rates of redo and tredo operation were significantly higher in group 1 compared to group 2 ( p = 0.01 and 0.04). In multivariate analysis, phosphate (OR: 1.84, 95% CI: 1.00–3.40, p = 0.05) and triglyceride (OR: 1.01, 95% CI: 1.00–1.02, p = 0.04) levels for redo operation and calcium phosphate product level (OR: 1.11, 95% CI: 1.01–1.22, p = 0.03) for tredo operation were found to be independent predictors. Conclusions High calcium phosphate product level leads to increased risk of arteriovenous fistula re-operation by causing arterial stiffness in this patient group. Additionally, these re-operations place additional burden on morbidity and cost efficacy. Thus, we recommend keeping the calcium phosphate product level at the optimal level in these patients to avoid both the risk of arteriovenous fistula re-operation and the other cardiovascular problems.

Intimal CD31-Positive Relative Surfaces Are Associated with Systemic Inflammatory Markers and Maturation of Arteriovenous Fistula in Dialysis Patients

“…Additionally, the high baseline level of total serum calcium acts as protective factor against vascular access maturation failure (OR:0.17, p = 0.002). Similar to our results, Tuysuz et al [ 60 ] demonstrated in a group of 79 patients that serum levels of phosphate (OR: 1.85, p = 0.05) and Ca-P product (OR: 1.11, p = 0.03) were predictive factors of AVF re-operation. Moreover, Unver et al [ 61 ] demonstrated that high values of Ca-P product are associated with lower blood flow rates ( p = 0.03).…”

“…The serum levels of calcium, phosphate, and Ca-P product have an important role in the homeostasis and optimal functioning of the cardiovascular system [ 3 , 60 , 61 ]. According to the results of our study, the low level of serum calcium ( p = 0.0002), the increased level of serum phosphate ( p < 0.0001), and the increased values of Ca-P product ( p < 0.0001) are associated with AVF maturation failure.…”

A retrospective comparison analysis of results of drug-coated balloon versus plain balloon angioplasty in treatment of juxta-anastomotic de novo stenosis of radiocephalic arteriovenous fistulas

“…Older age, female sex, obesity, diabetes mellitus, extensive vascular disease, surgeon's experience, and even increased calcium phosphate product levels have been thought as the main clinical and chemical predictors of establishment and maintenance of vascular access. [11][12][13][14][15] Effective access surveillance and maintenance programs should be based on routine physical and CDUS examination, and surgical/endovascular intervention modalities should be considered, if needed. Currently, the benefit of surgeon-based CDUS concept has become more apparent in vascular access surgery.…”