The Impact of Ischemic Heart Disease on Early Arteriovenous Fistula Failure in Nondiabetic Hemodialysis Patients

Kim, Young Ok; Song, Ho Cheol; Yoon, Sun Ae; Kim, Young Soo; Yang, Chul Woo; Lee, Seung Hun; Kim, Yong Soo; Kim, Suk Young; Choi, Euy Jin; Chang, Yoon Sik; Bang, Byung Kee

Abstract

BACKGROUND
Atherosclerotic lesion of coronary artery frequently accompanies intimal hyperplasia of radial artery. We have reported that the lesion of radial artery (intimal hyperplasia) in hemodialysis (HD) patients is associated with early failure of arteriovenous fistula (AVF) as well as ischemic heart disease (IHD) (Am J Kidney Dis 41: 422-428, 2003). This study was designed to determine the impact of IHD on the early failure of AVF in nondiabetic HD patients. METHODS: This study enrolled 125 nondiabetic HD patients who received radiocephalic AVF operation for the first time. We evaluated IHD before the operation through clinical symptom and electrocardiography and then investigated AVF failure within 1 year after the operation. We analyzed the AVF patency rates between the patients with and without IHD using Kaplan-Meier method and log-rank test. Multiple regression analysis was performed to identify independent risk factors of the AVF failure. RESULTS: The mean age of the patients was 48+/-14 years and the number of female was 54 (43.2%). Of the total 125 patients, 19 patients (15.4%) had IHD before the AVF operation. The AVF failure developed in 23 patients (18.4%) within 1 year after the operation. The AVF patency rate in the patients with IHD was lower than that in the patients without IHD (39.7% vs 88.3%, p<0.001). IHD and old age were independent risk factors of the AVF failure in nondiabetic HD patients. But sex, smoking history, hypertension, and the levels of hemoglobin, serum creatinine, albumin, and total cholesterol checked before the operation were not associated with the AVF failure. CONCLUSION: This study suggests that IHD is closely associated with early failure of AVF in nondiabetic HD patients.