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

Siew Cheng Chai; Zulkefli Sanip; Aida Hanum Ghulam Rasool; Amran Ahmed Shokri; Ahmad Sukari Halim; Arman Zaharil Mat Saad; Wan Azman Wan Sulaiman

doi:10.4103/jrms.JRMS_908_19

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Year : 2022 | Volume : 27 | Issue : 1 | Page : 46

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

Siew Cheng Chai¹, Zulkefli Sanip², Aida Hanum Ghulam Rasool³, Amran Ahmed Shokri⁴, Ahmad Sukari Halim⁵, Arman Zaharil Mat Saad⁵, Wan Azman Wan Sulaiman⁵
¹ Department of Plastic and Reconstructive Surgery, Hospital Kuala Lumpur, Federal Territory of Kuala Lumpur; Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
² Central Research Laboratory, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
³ Pharmacology Vascular Laboratory, Department of Pharmacology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
⁴ Hospital Universiti Sains Malaysia; Department of Orthopaedic, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
⁵ Reconstructive Sciences Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus; Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia

Correspondence Address:
Prof. Wan Azman Wan Sulaiman
Reconstructive Science Unit, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan
Malaysia

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jrms.JRMS_908_19

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], P = 0.001) while systolic blood pressure was lower (142.25 [SD 21.50] vs. 162.25 [SD 13.26], P = 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.

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