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, 12 (1), 113-121

Monocyte Chemoattractant Protein-1 Levels and Postangioplasty Restenosis of Arteriovenous Fistulas

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Monocyte Chemoattractant Protein-1 Levels and Postangioplasty Restenosis of Arteriovenous Fistulas

Chih-Cheng Wu et al. Clin J Am Soc Nephrol.

Abstract

Background and objectives: Inflammation is relevant in restenosis of atherosclerotic vascular diseases, but its role in dialysis arteriovenous fistula remains unknown. In animal studies, upregulation of monocyte chemoattractant protein-1 has been shown in venous segments of arteriovenous fistula. We, therefore, aimed to investigate serial changes in circulating monocyte chemoattractant protein-1 after percutaneous transluminal angioplasty of dialysis arteriovenous fistulas and its relation to restenosis.

Design, setting, participants, & measurements: Fifty-nine patients with dysfunctional arteriovenous fistulas that were referred for percutaneous transluminal angioplasty were enrolled prospectively between January of 2010 and July of 2012. Three of them were excluded due to percutaneous transluminal angioplasty failure or acute infection. Blood was sampled from arteriovenous fistulas at baseline, 2 days, 2 weeks, and 3 months after percutaneous transluminal angioplasty. Clinical follow-up was continued monthly for 3 months. Angiographic follow-up was arranged at the end of 3 months. Seventeen patients without significant stenosis were enrolled as the control group.

Results: Fifty-six patients completed clinical follow-up. Significant increases in monocyte chemoattractant protein-1 were observed at 2 days and 2 weeks (both P<0.001) after percutaneous transluminal angioplasty. Twenty-three (41%) patients had symptomatic restenosis. The restenosis group had a higher percentage change in monocyte chemoattractant protein-1 levels at 2 days (median =47%; interquartile range, 27%-65% versus median =17%; interquartile range, 10%-25%; P<0.001) after percutaneous transluminal angioplasty compared with the patent group. Fifty-two patients completed angiographic follow-up. A positive correlation between relative luminal loss and monocyte chemoattractant protein-1 increase at 2 days after percutaneous transluminal angioplasty was found (r=0.53; P<0.001). In multivariate analysis, postangioplasty monocyte chemoattractant protein-1 increase at 2 days was an independent predictor of restenosis. Using receiver operator characteristic analysis, >25% postangioplasty increase of monocyte chemoattractant protein-1 was significantly associated with restenosis after percutaneous transluminal angioplasty (hazard ratio, 5.36; 95% confidence interval, 1.81 to 15.8).

Conclusions: Circulating monocyte chemoattractant protein-1 levels were elevated 2 days and 2 weeks after percutaneous transluminal angioplasty. Early postangioplasty increase of monocyte chemoattractant protein-1 level was associated with restenosis of arteriovenous fistulas.

Keywords: angioplasty; arterioveous fistula; hemodialysis; monocyte chemoattractant protein-1; stenosis.

Figures

Figure 1.
Figure 1.
Study flow and design for cohort and follow-up (F/U). BS, blood sampling; D, day; DSA, digitally subtracted angiography; HD, hemodialysis; M, month; PTA, percutaneous transluminal angioplasty; W, week.
Figure 2.
Figure 2.
Serial change of plasma monocyte chemoattractant protein-1 (MCP-1) levels before and at 2 days (2D), 2 weeks (2WK), and 3 months (3MO) after percutaneous transluminal angioplasty (PTA). (A) Control group (black circles) versus PTA group (white squares). (B) Restenosis group (white squares) versus patent group (black circles); data are means ±95% confidence intervals.
Figure 3.
Figure 3.
Correlation between monocyte chemoattractant protein-1 (MCP-1) levels and relative luminal loss by follow-up angiography. (A) No correlation between baseline MCP-1 and relative luminal loss. (B) Positive correlation between percentage increase of MCP-1 at 2 days (48HR) after percutaneous transluminal angioplasty and relative luminal loss.
Figure 4.
Figure 4.
Monocyte chemoattractant protein-1 increase predicts restenosis. (A) Receiver operator characteristic curve of postangioplasty monocyte chemoattractant protein-1 (MCP-1) increase for clinical restenosis. The area under receiver operator characteristic curve (AUC) was 0.86±0.05, which was significantly different from a random distribution (P<0.001). (B) Kaplan–Meier analyses showing the proportion of patients without clinical restenosis. Patients are divided according to a cutoff value of 25% postangioplasty MCP-1 increase. PTA, percutaneous transluminal angioplasty.

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