Background: The relationship between the endothelial glycocalyx constituents and the early failure of autologous arteriovenous fistulas (AVFs) in ESRD patients is still unknown.
Methods: In this prospective cohort study, 181 ESRD patients (the mean age was 53.3 ± 11.8 years, 66.3% of them were males) received forearm AVFs surgery were consecutively enrolled with a median follow-up time of 10 months. The early AVF failure was defined as a fistula that never developed adequately for dialysis use or that failed within the first 3 months of use. The serum levels of glycocalyx constituents including glypicans-1 (GPC-1), syndecans-1 (SDC-1), and hyaluronan (HA), and the indicator of endothelial activation reflected by E-selectin (ES) were determined by ELISAs.
Results: The primary patencies of AVFs were 98.3%, 96.7%, 91.7%, and 89.5% at 3, 6, 12, and 18 months, respectively. The ROC curve was plotted and demonstrated that HA, not GPC-1, SDC-1 or ES, can diagnose the AVF failure, with the cut-off value of 6.37 ng/ml, the sensitivity of 87.5%, the specificity of 46.9%, and the Youden index of 0.34, respectively. The Kaplan-Meier survival analysis demonstrated that patients with HA < 6.37 ng/mL had better patency of AVFs than patients with HA ≥ 6.37 ng/mL (log-rank test, p = 0.008). In the Cox proportional hazards analysis, after adjusting for confounders, HA (≥ 6.37 ng/mL vs. < 6.37 ng/mL) was associated with the early AVFs failure, with the OR of 5.88 (1.21-28.60).
Conclusions: This study demonstrated that HA can predict the early failure of forearm AVFs, when its serum level is more than 6.37 ng/mL.
Keywords: Autologous arteriovenous fistula; Endothelial glycocalyx; Patency; Prognosis.