# Aortic Calcification Can Serve as an Independent Predictor of Arteriovenous Fistula Failure in Maintenance Hemodialysis Patients

## TL;DR

Aortic calcification can predict failure of blood vessels used for dialysis in patients with kidney disease.

## Contribution

Aortic calcification score is shown to independently predict arteriovenous fistula failure in hemodialysis patients.

## Key findings

- High aortic calcification was present in 93.33% of patients.
- High calcification group had significantly lower fistula patency rates over five years.
- ACI was a significant risk factor for fistula dysfunction in Cox analysis.

## Abstract

Background

This study aimed to observe the relationship between aortic calcification and the primary patency rate of new autologous internal fistulas in maintenance hemodialysis patients and to explore the possibility of predicting the dysfunction of autologous internal fistulas using the aortic calcification score.

Methodology

A total of 75 patients who underwent autologous arteriovenous fistula and hemodialysis for the first time in our hospital between January 2016 and December 2019 were selected. Abdominal aortic calcification index (ACI) was recorded at the time of internal fistula establishment. Patients were divided into high- and low-calcification groups based on the ACI results. The primary patency rate of autologous internal fistulas in the two groups was observed over five years.

Results

Of the 75 patients, 70 (93.33%) had varying degrees of aortic calcification, with 37 patients in the high calcification group (ACI > 10%). During the five-year follow-up period, 64 patients developed internal fistula dysfunction due to various causes, including 35 cases of thrombosis and 19 cases of fistula stenosis. At 12, 36, and 60 months, the primary patency rates of internal fistulas in the low calcification group were 92.5%, 57.5%, and 17.5%, respectively, whereas those in the high calcification group were 85.7%, 30.4%, and 9.1%, respectively. The difference in primary patency rates between the two groups was statistically significant after five years (F = 4.443, p = 0.035). Cox analysis showed that autologous internal fistula dysfunction was related to ACI (hazard ratio = 2.114, 95% confidence interval = 1.146-3.899, p = 0.017).

Conclusions

A higher aortic calcification score was associated with dysfunction of the autologous arteriovenous fistula within five years. Patients with higher aortic calcification scores require more frequent monitoring of the internal fistula function and early intervention to prolong the service life of the internal fistula.