Association Between Vascular Access Type and Visceral and Peripheral Body Fat, Nutritional and Inflammatory Parameters in Incident Hemodialysis Patients

Abstract

OBJECTIVE: Central venous catheters (CVCs) are preferred when a patent arteriovenous fistula (AVF) cannot be created. CVCs have been shown to be associated with increased inflammation and mortality. In the present study, we aimed to investigate a probable association between the vascular access type and BMI, total body fat, truncal fat, muscle mass, visceral (periaortic) fat, and the malnutrition inflammation atherosclerosis and calcification score (MIAC) in hemodialysis patients

MATERIAL and METHODS: A total of 119 patients were involved. Ninety patients had patent AVF and 29 patients were undergoing hemodialysis via permanent jugular catheter. Two-dimensional echocardiography was performed to detect valvular calcification. Computed tomography was performed in all patients to detect the amount of thoracic periaortic fat tissue (T-PAFT). Biochemical analyses were performed using c8000 Architect. MIAC scores were calculated using valvular calcification, albumin, and CRP. Total body fat and truncal fat were detected using the bio impedance analysis method. Aortic calcification score (AoCS) was calculated using routine chest x-rays

RESULTS: MIAC and AoCS was higher in patients with CVC (p=0.02 and 0.032). T-PA FT was higher in patients with AV (1631.5 +/- 645 vs 1112.2 +/- 606.8; p=0.035). CRP was higher in patients with CVC (p=0.04). Hemodialysis vintage, calcium and albumin were lower in patients with CVC Truncal fat (%), cholesterol and 25-OH vitamin D levels were lower in patients with CVC (p=0.04, p=0.02, p=0.03). T-PA FT was a significant predictor of vascular access type in favour of AVF (t=-2.17; p=0.04)

CONCLUSION: The present study revealed that HI) patients with CVC had increased inflammation and decreased nutrition, visceral and truncal fat. Further prospective studies are needed to illuminate the relationship between vascular access type, nutritional parameters and body composition in HD patients.