Anthropometric parameters of nutritional assessment as predictive factors of arteriovenous fistula malfunction in patients undergoing hemodialysis.

Abstract

INTRODUCTION To evaluate the role of body mass index (BMI), waist circumference (W-C) and waist/hip ratio (WHR) on arteriovenous fistula (AVF) dysfunction. METHODS We evaluated 84 HD patients with an average follow-up period of 31.3 ± 8.1 months, identifying 8 stenosis (STN) and 17 thrombosis (THR) cases. The association between paired variables was tested with Pearson's coefficient (r) and p-value, whereas the prognostic value on STN and THR was analysed using Cox's regression. The significant independent variables were indentified with an inverse step-wise approach defining the data as hazard ratio (HR). A double-event (Stenosis/Thrombosis) model, function of Body mass index and Waist/hip ratio was used. Arteriovenous fistula survival was assessed with the Kaplan-Meyer curve and the calculations were carried out with Graph-Pad. RESULTS On univariate analysis, THR showed direct correlation with BMI (r=0.44, p<0.01), W-C (r=0.39, p<0.05) WHR (r=0.37, p<0.01), Hemoglobin (p<0.001), C-Reactive protein (p=0.01), Calcium/Phosforus product (p=0.03), Parathyroid hormone (p=0.03) and inverse with albumin (p<0.001) and systolic blood pressure (p=0.003). On multivariate analysis, BMI variations were not predictive of STN and THR, whereas each unitary WHR and W-C increase was predictive of an increase of risk of events (3.8% and 2.1% respectively). The prognostic power of W-C per STN (HR 1: 1.19; p<0.05) and THR (HR: 1.28; p<0.01) remained significant even after being adjusted to account for traditional risk factors. CONCLUSIONS Abdominal obesity increases the risk of AVF dysfunction. The W-C and WHR parameters, not BMI, emerge as independent STN and THR predictors.

DOI: 10.5301/jva.5000096

Cite this paper

@article{Gagliardi2012AnthropometricPO, title={Anthropometric parameters of nutritional assessment as predictive factors of arteriovenous fistula malfunction in patients undergoing hemodialysis.}, author={Gian Manlio Gagliardi and Domenico Mancuso and Enrica Falbo and Francesco Mollica and Agata Mollica and Elisabetta Barcellona and Massimo Senatore and Renzo Bonofiglio}, journal={The journal of vascular access}, year={2012}, volume={13 4}, pages={475-81} }