Factors affecting the primary patency of native arteriovenous fistulas after ultrasound-guided percutaneous transluminal angioplasty

Figures & data

Figure 1. Flowchart of study participants.

Table 1. Baseline characteristics (at first UG-PTA) by number of PTAs during follow-up.

Variable	Overall	Number of PTAs		p Value
		1	>1
Number of patients	199	128 (64.3%)	71 (35.7%)
Age, years	52.9 (13.5)	53.34 (13.68)	52.18 (13.18)	.562
Male, n (%)	97 (48.7%)	65 (50.8%)	35 (49.3%)	.841
Follow-up time, months	21.0 (14.5, 28.9)	20.1 (14.5, 28.9)	22.5 (16.0, 30.8)	.304
BMI, kg/m^2	20.8 (18.9, 24.0)	20.8 (19.0, 24.0)	20.5 (18.6, 24.1)	.687
SBP, mmHg	150.0 (136.0, 160.0)	150.0 (135.0, 163.0)	149.0 (137.0, 160.0)	.569
Smoking, n (%)	40 (20.1%)	21 (16.4%)	19 (26.8%)	.08
Drinking, n (%)^*	23 (11.6%)	10 (7.8%)	13 (18.3%)	.026
Comorbidities, n (%)
Diabetes	55 (27.6%)	40 (31.3%)	15 (21.1%)	.126
Hypertension	169 (84.9%)	107 (83.6%)	63 (88.7%)	.325
Cardiovascular disease	41 (20.6%)	25 (19.5%)	16 (22.5%)	.615
Cerebrovascular disease	17 (8.5%)	11 (8.6%)	6 (8.5%)	.972
Peripheral vascular disease	13 (6.5%)	7 (5.5%)	6 (8.5%)	.412
AVF vintage, months	11 (5, 24)	12.00 (4.9, 24.0)	8.0 (4.8, 19.5)	.274
Previously failed AVF, n (%)^*	33 (16.6%)	14 (10.9%)	19 (26.8%)	.008
Tunneled dialysis catheter before dialysis, n (%)	134 (67.3%)	85 (66.4%)	49 (69.0%)	.700
Dialysis frequency (times per week), n (%)				0.703
2/week	32 (16.1%)	21 (16.4%)	11 (15.5%)
5/2 week	60 (30.2%)	36 (28.1%)	24 (33.8%)
3/week	107 (53.8%)	71 (55.5%)	36 (50.7%)
Laboratory values
MCH, pg (normal range 27.0–34.0)	30.5 (29.2, 32.2)	30.6 (29.2, 32.1)	30.4 (29.2, 32.5)	.868
NLR (normal range 1.6–2.0)	3.6 (2.6, 4.7)	3.6 (2.6, 5.0)	3.5 (2.6, 4.6)	.977
P-LCR^* (normal range 13.0–43.0)	27.9 (22.8, 37.4)	28.8 (24.7, 38.3)	25.9 (22.0, 36.1)	.024
MPV, fL^* (normal range 8.0–15.0)	10.4 (9.8, 11.5)	10.6 (10.0, 11.7)	10.2 (9.6, 11.3)	.022
Platelets, ×10^9/L (normal range 125.0–350.0)	158.0 (116.5, 202.0)	158.5 (118.3, 200.0)	150.0 (111.8, 206.3)	.901
BUN, mmol/L (normal range 3.6–9.5)	21.5 (8.2)	21.2 (7.4)	22.0 (9.5)	.551
Scr, μmol/L (normal range 59.0–104.0)	820.0 (640.0, 1043.0)	819.0 (651.0, 1043.0)	820.0 (624.0, 1049.0)	.988
Uric acid, μmol/L (normal range 202.3–416.5)	382.0 (126.2)	382.5 (124.2)	381.3 (130.5)	.948
Corrected calcium, mmol/L (normal range 2.1–2.5)	2.2 (0.23)	2.2 (0.23)	2.2 (0.22)	.872
Phosphorus, mmol/L (normal range 0.8–1.4)	1.8 (1.5, 2.1)	1.8 (1.4, 2.0)	1.8 (1.5, 2.3)	.06
Ca–P^* (normal range 1.6–3.5)	3.8 (3.0, 4.7)	3.7 (2.8, 4.6)	4.0 (3.2, 5.3)	.035
Sodium, mmol/L (normal range 136.0–145.0)	139.1 (137.2, 140.8)	139.0 (137.2, 140.8)	139.4 (137.2, 141.1)	.670
Potassium, mmol/L (normal range 3.5–5.1)	5.0 (4.5, 5.5)	5.0 (4.5, 5.4)	4.9 (4.5, 5.5)	.804
High-sensitive C-reactive protein, mg/dL^* (normal range 0.1–3.0)	3.2 (2.0, 6.7)	2.7 (2.0, 4.6)	5.0 (3.0, 6.9)	.01
Hemoglobin, g/L (normal range 130.0–175.0)	106.7 (19.6)	108.0 (18.4)	104.3 (21.4)	.213
Albumin, g/L (normal range 35.0–52.0)	42.0 (4.9)	41.8 (5.1)	42.4 (4.5)	.412
PTH, pg/mL^* (normal range 15.0–65.0)	228.8 (123.8, 474.1)	203.0 (116.4, 370.7)	338.1 (150.9, 702.1)	.012
APTT, s (normal range 29.0–42.0)	39.3 (36.3, 39.3)	39.1 (36.3, 42.30)	39.1 (36.4, 42.9)	.894
Total cholesterol, mmol/L (normal range <5.2)	3.8 (0.9)	3.8 (0.85)	3.7 (0.88)	.817
Triglycerides, mmol/L (normal range <1.7)	1.6 (1.1, 2.4)	1.5 (1.1, 2.3)	1.7 (1.2, 2.4)	.321
Medications, n (%)
Antiplatelet agent	23 (11.6%)	16 (12.5%)	7 (9.9%)	.577
Stain	26 (13.1%)	15 (11.7%)	11 (15.5%)	.500
Insulin	45 (22.6%)	32 (25.0%)	13 (18.3%)	.169
Treatment for HPT^a	71 (35.7%)	55 (43.0%)	30 (42.3%)	.922

PTA: percutaneous transluminal angioplasty; BMI: body mass index; SBP: systolic blood pressure; AVF: arteriovenous fistula; MCH: mean hemoglobin content; NLR: neutrophil–lymphocyte ratio; P-LCR: platelet-larger cell ratio; MPV: mean platelet volume; BUN: blood urea nitrogen; SCR: serum creatinine; Ca–P: calcium–phosphate product; PTH: parathyroid hormone; APTT: activated partial thromboplastin time; HPT: hyperparathyroidism.

Values for categorical variables are given as number (percentage); values for continuous variables are given as mean ± standard deviation or median (interquartile range).

^a Drug treatment for HPT included cinacalcet, paricalcitol, and sevelamer.

^* p < .05, and the p-value is bolded with black lines.

Table 2. Ultrasonographic examinations of the 199 procedures.

Variable	Overall	Number of PTAs		p Value
		1	>1
Number of patients	199	128 (64.3%)	71 (35.7%)
Lesion length (cm), n (%)				0.095
≤2 cm	88 (44.2%)	51 (40%)	37 (52%)
>2 cm	111 (55.8%)	77 (60%)	34 (48%)
Number of lesions, n (%)				0.472
Single	65 (32.7%)	39 (30.5%)	26 (36.6%)
Multiple	134 (67.3%)	89 (69.5%)	45 (63.4%)
Postoperative brachial flow, mL/min	760.0 (600.0, 960.0)	790.0 (624.0, 920.0)	736.0 (500.0, 900.0)	.211
Preoperative brachial flow, mL/min	253.0 (175.0, 400.0)	270.0 (200.0, 332.5)	200.0 (150.0, 445.5)	.297
Balloon size, mm, n (%)				.153
5	30 (15.1)	16 (12.5)	14 (19.7)
6	130 (65.3)	93 (72.7)	37 (52.1)
7	27 (13.6)	15 (11.7)	12 (16.9)
Other size	31 (15.6)	20 (15.6)	11 (15.5)
Lesion location, n (%)				.272
Juxta-AVF	47 (23.6%)	34 (26.6%)	13 (18.3%)
OFV	69 (34.7%)	47 (36.7%)	22 (31.0%)
Juxta AVF &OFV	64 (32.1%)	36 (28.1%)	28 (39.4%)
Juxta AVF/OFV and Artery	19 (9.5%)	11 (8.6%)	8 (11.3%)
Thrombosed	51 (25.6%)	32 (25.0%)	19 (26.8%)	.326

Juxta-AVF: juxta arteriovenous fistula defined as within 2 cm of arteriovenous anastomosis; OFV: outflow vein.

Values for categorical variables are given as number (percentage); values for continuous variables are given as mean ± standard deviation or median (interquartile range).

Figure 2. AVF survival curves after 6-, 12-, and 24-months follow-up. (a) Primary patency. (b) Secondary patency.

Table 3. Success and complication rates.

Number of patients	199
Complication rate, n (%)
Hematoma, n (%)	20 (9.8)
Thrombosis, n (%)	2 (1.0)
Type of intervention
Conventional UG-PTA, n (%)	163 (81.9)
Cutting balloons, n (%)	34 (17.1)
Conventional UG-PTA & vein ligation, n (%)	2 (1.0)

UG-PTA: ultrasound-guided percutaneous transluminal angioplasty.

Figure 3. Kaplan–Meier’s cure of estimated primary patency. (a) Comparisons between PTH < 394 pg/mL and ≥394 pg/mL. (b) Comparison between non-previously failed AVF and previously failed AVF.

Table 4. Univariate and multivariate analyses of the effect of baseline patient characteristics on primary patency.

Variable	Univariate analysis			Multivariable analysis
	HR	95% CI	p Value	HR	95% CI	p Value
Age, per 1 y older	0.999	0.982–1.017	.940
Male sex	1.012	0.631–1.624	.960
Smoking	1.623	0.954–2.762	.74
Drinking	1.759	0.958–3.230	.069
Previously failed AVF	2.093	1.233–3.553	.006*	1.935	1.071–3.494	.029*
High-sensitive C-reactive protein, per 1 mg/dL greater	1.047	0.993–1.104	.086
P-LCR	0.972	0.946–0.998	.035*	0.921	0.702–1.209	.554
MPV, per 1 fL greater	0.806	0.655–0.992	.042*	0.921	0.702–1.209	.554
Ca–P	1.207	1.052–1.385	.007*	0.794	0.469–1.346	.392
Phosphorus, per 1 mmol/L greater	1.538	1.079–2.193	.017*	1.640	0.433–6.205	.467
PTH, per 100 pg/mL greater	1.139	1.052–1.233	.001*	1.105	1.014–1.203	.004*

HR: hazard ratio; CI: confidence interval; P-LCR: platelet-larger cell ratio; MPV: mean platelet volume; Ca–P: calcium–phosphate product.

* p < .05.

Data availability statement

The data underlying this article will be shared on reasonable request with the corresponding authors.