Systemic microvascular endothelial function with arteriovenous fistula creation in chronic kidney disease.

Background: This study aimed to determine changes in microvascular endothelial function with upper arm arteriovenous fistula (AVF) creation and maturation in patients with chronic kidney disease (CKD).

Materials And Methods: This prospective cross-sectional study was performed at Hospital Universiti Sains Malaysia, a tertiary hospital in Malaysia. Forty CKD patients (stage 4-5) who were scheduled for elective AVF creation over the upper extremity for maintenance hemodialysis were recruited using convenience sampling method. Microvascular endothelial-dependent vasodilation was measured using laser Doppler flowmetry and the process of iontophoresis preoperatively and postoperatively at weeks 2 and 6. Fistula maturation was assessed at week 6.

Results: Thirty-two patients had successful AVF maturation. Endothelial-dependent vasodilation (acetylcholine (Ach)% was higher (246.48 [standard deviation (SD) 209.38] vs. 104.95 [SD 43.29], = 0.001) while systolic blood pressure was lower (142.25 [SD 21.50] vs. 162.25 [SD 13.26], = 0.017) in this group as compared to unsuccessful AVF group. No significant changes were seen in overall microvascular endothelial-dependent vasodilation during the 6-week study period (day 0, 246.48 [SD 209.38]; week 2, 201.14 [SD 198.19]; and week 6, 203.53 [SD 145.89]).

Conclusion: Upper arm AVF creation does not affect microvascular endothelial function up to 6 weeks post operation and may not contribute to the success of AVF maturation. However, the lower microvascular endothelial-dependent vasodilation and higher systolic blood pressure in unsuccessful AVF subjects need to be further studied.