Pos-606 Can We Improve Endothelial Injury to Prevent Vascular Access Thrombosis for Hemodialysis?

Abstract

Introduction: Vascular access (VA) for hemodialysis is essential for kidney patients because of its associated morbidity and mortality as well as for its impact on quality of life. Thrombosis is the main complication of an arteriovenous fistula (AVF). The main cause is the previous stenosis, which occurs due to the hyperplasia of the neointima of the vessel, that conditions the appearance of thrombosis. The efficacy of different approaches has been studied to reduce the incidence of thrombosis in AVFs and increase their survival. We determine those factors involved in vascular access thrombosis for hemodialysis. Methods: This is a cross-sectional descriptive study. We include all the AVFs performed in our center during the period between 2000 and 2020. Demographic variables (age, sex), CKD etiology and associated comorbidity factors were collected. We determine the factors involved in thrombosis of AVFs. The statistical analysis was executed with SPSS 25.0. The categorical variables are expressed as percentages and were compared using the Chi2 test. The quantitative variables are expressed as mean +/-standard deviation, and the T-Student or U Mann Whitney were used to compare them. We performed multivariate analysis using logistic regression. We establish statistical significance for a value of p <0.05. Results: We include 622 AVFs performed in 482 patients. 86.8% were autologous. 66.6% were male, with an average age of 65.4 AE 14 years. The most frequent CKD etiology were diabetic nephropathy (30.2%), unknown etiology (18%), and glomerular etiology (16.6%). 91.2% had high blood pressure (HBP) and 47.9% diabetes mellitus (DM). 48.7% received antiplatelet therapy and 15.6% anticoagulation prior to the creation of the AVF. VA thrombosis was documented in 23%. The univariate analysis showed statistical significance for ischemic heart disease (p = 0.05), peripheral vascular disease (p = 0.05), antiplatelet therapy (p = 0.038), high phosphorous levels (p = 0.033), high PTH levels (p = 0.024) and C-reactive protein (p = 0.021). When performing the multivariate analysis using logistic regression, antiplatelet therapy (OR: 0.62 95% CI 0.41-0.93 p = 0.023), and statin treatment (OR: 0.58 95% CI 0.36-0, 93 p = 0.025) are protective factors for VA thrombosis. Conclusions: In our study, antiplatelet therapy prior to the creation of the VA decreased the probability of AVF thrombosis by 38% and the statin treatment decreased the probability of AVF thrombosis by 42%.