Akademik Veri Yönetim Sistemi
ISTANBUL MEDICAL JOURNAL, cilt.26, sa.2, ss.88-93, 2025 (ESCI, TRDizin)
Introduction: Although arteriovenous fistula (AVF) is the preferred vascular access in hemodialysis (HD) practice, AVF maturation is a common issue. The current study investigated the possible role of preoperative serum calcium/phosphate levels in predicting AVF maturation.
Methods: Only patients with end-stage kidney disease who were candidates for chronic HD were included. The key inclusion criterion was having a newly created radiocephalic AVF. Patients who started chronic HD before AVF operation were excluded. A mature AVF was defined as blood flow >500 mL/minute and an access (cephalic) vein diameter >5 mm at 6 to 8 weeks post-operation, in ultrasonography. Results: A total of 79 patients were included, with a median age of 62.4 years. AVF maturation was identified in 50 patients (63.3%). Serum calcium level was 8.9 +/- 0.6 mg/dL in patients with mature AVF and 8.6 +/- 0.5 mg/dL in patients with immature AVF (p=0.03). Hypocalcemia was more frequent (31.0% compared to 16%) in patients with immature AVF, whereas it was not statistically significant (p=0.117). A positive correlation was identified between serum calcium levels and cephalic vein diameters (p=0.012). Serum phosphate, parathyroid hormone, and calcium phosphate product were not significantly different between the two groups. Logistic regression analysis revealed that serum calcium level was an independent predictor for AVF maturation (p=0.035). In receiver operating characteristic analysis, sensitivity and specificity of calcium level (cut-off >8.7 mg/dL) were 70.0% and 59.6%, respectively, with an area under the curve of 0.65 (95% confidence interval 52.4-77.6, p=0.027).
Conclusion: Understanding the impact of preoperative calcium levels on AVF maturation may guide clinicians in optimizing biochemical parameters preoperatively, thus enhancing fistula success rates.