A. Dejman1, J. C. Duque2, L. Martinez3, L. Salman4, R. Vazquez-Padron3, M. Tabbara3 1University Of Miami,Nephrology,Miami, FL, USA 2University Of Miami,Medicine,Miami, FL, USA 3University Of Miami,Suergery,Miami, FL, USA 4University Of Miami,Interventional Nephrology,Miami, FL, USA
Introduction:
Arteriovenous fistulas (AVF) for hemodialysis in ESRD patients is the preferred vascular access type and it currently remains to be one of the areas under profound research given the high rates of failure, complications and cost burden for the health system. Multiple advances in vascular diseases in HIV patients independent to hemodialysis accesses have been reported. One remarkable connotation is the role of the HIV virus and the direct effect in the vessel wall, in which some authors have shown that these patients have a higher incidence of cardiovascular illnesses with elevated morbidity and mortality and poor vascular outcomes. Unfortunately, the impact of the Human Immunodeficiency Virus (HIV) in the AVF remodeling and outcomes is not well known.
Methods:
This retrospective study assessed the impact of HIV infection on one-stage and two-stage hemodialysis AVF outcomes. The study included 494 patients but only 42 patients were HIV positive. All of them underwent an AVF creation at the University of Miami/Jackson Memorial Hospital from 2008 to 2014. The effects of HIV on primary failure were determined using multivariate logistic regressions and Cox proportional hazard models adjusted for 10 clinical and demographic covariates.
Results:
Primary failure was not correlated with clinical including medications and demographic covariates, but population was relatively younger than controls. Patients with diagnosis of HIV had a positive correlation with AVF primary failure (p=0.004) no mater the anastomosis type. Patients with HIV and history of previous AVF had association with primary failure (p=0.002). Moreover different access such as Tunneled dialysis catheters showed correlation with primary failure (p=0.012) A T-cell subset including (CD3, CD4, or CD8) did not show any association with primary failure.
Conclusion:
Our results suggest that HIV immunosuppression may play a role in AVF outcomes specially primary failure. HIV infection relates to increased rate of AVF primary failure, but this is not explained by the T-cell subset counts and there should be a different immunological relationship between AVF failure and vascular remodeling.