Malnutrition affects arteriovenous fistula outcome
Hemodialysis patients who are malnourished face an additional risk for all-cause mortality, say Italian nephrologists (Spatola L et al, Subjective Global Assessment-Dialysis Malnutrition Score and arteriovenous fistula outcome: A comparison with Charlson Comorbidity Index. J Vasc Access. 2018; doi: 10.1177/1129729818779550).
However, while this fact is well-recognized, the exact link between malnutrition and arteriovenous fistula outcome is not yet well understood. In the present study, the authors investigate malnutrition as an independent predictor of arteriovenous fistulas thrombosis (vascular access thrombosis) and/or significant stenosis (vascular access stenosis).
57 hemodialysis patients were included in the two-year study. Malnutrition was defined by the “Subjective Global Assessment–Dialysis Malnutrition Score”. The results of the study were as follows:
- Higher albumin and normalized protein catabolic rate levels had a protective role against vascular access failure (OR = 0.67 and 0.46, respectively).
- A higher “Subjective Global Assessment–Dialysis Malnutrition Score” and higher “Charlson Comorbidity Index” values were significant risk factors for access failure (HR = 1.42 and 1.48, respectively).
- The area under the curve of the “Subjective Global Assessment–Dialysis Malnutrition Score” was significantly higher than those found with both the “Charlson Comorbidity Index” and the “modified Charlson Comorbidity Index”: 0.70 (95% CI = 0.50; 0.88) versus 0.61 and 0.55.
Malnutrition and comorbidity are “useful tools to predict vascular access failure”, conclude the authors. They suggest that these scores should be “carefully and periodically evaluated to check for significant variations that may compromise vascular access survival”.