Korean J Med.  2020 Feb;95(1):36-42. 10.3904/kjm.2020.95.1.36.

The Relationship between Serum Phosphorous Level and Arteriovenous Fistula Dysfunction in Maintenance Hemodialysis Patients

• Choi YB
• Kim JH
• Lee MJ
• Choi S
• Kim HJ

• KMID: 2501893
• DOI: http://doi.org/10.3904/kjm.2020.95.1.36

Abstract

Background/Aims
Maintaining vascular access (VA) is very important in the management of hemodialysis (HD) patients. Therefore, the identification of risk factors for decreased vascular access flow has clinical relevance. The aim of the present study was to investigate the impact of serum phosphorus (P) on autologous arteriovenous fistula flow in HD patients.
Methods
Sixty-two maintenance HD patients who visited the dialysis unit of CHA Bundang Medical Center between November 2016 and December 2017 were included in the study. Serum P levels were obtained every month, and time-averaged serum P was calculated. All patients had left arm arteriovenous fistulas (AVF; side-to-side anastomosis). AVF flow was assessed by Transonic HD 03. Decreased AVF flow was defined as < 600 mL/min.
Results
Decreased AVF flow was observed in 14 of 62 patients. In univariate analysis and multivariable analysis, higher serum P had a significant independent association with decreased AVF flow. Advanced age, reduced ejection fraction, low blood flow rate in dialysis, and higher serum calcium were not associated with AVF flow.
Conclusions
The present study demonstrated that higher serum P was an independent risk factor for decreased autologous AVF flow in maintenance HD patients. Serial monitoring of serum P may be helpful in stratifying patients by risk of AVF dysfunction, and proper management of serum P levels may be helpful in maintaining flow through autologous AVFs.

Keyword

동정맥루; 인; 투석; Arteriovenous fistula; Phosphorus; Dialysis