Maduración de las fístulas arteriovenosas nativas: influencia de los factores inflamatorios, bioquímicos y hematológicos

• Rubio Castañeda, Francisco Javier ^[1] ; Fernández Núñez, Manuel ^[2] ; Sierra Sánchez, Ana Isabel ^[3] ; Mateo Sánchez, María Amaya ^[3] ; Chico Guerra, Johanna ^[1] ; Ferrer López, EMILIA ^[1]
  1. [1] Instituto de Investigación Sanitaria de Aragón (IISA). Unidad de Hemodiálisis y Trasplante Renal del Hospital Universitario Miguel Servet de Zaragoza. España
  2. [2] Unidad de Hemodiálisis y Trasplante Renal del Hospital Universitario Miguel Servet de Zaragoza. España
  3. [3] Unidad de Hemodiálisis y Trasplante Renal del Hospital Universitario Miguel Servet de Zaragoza. Españ

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• Localización: Enfermería Nefrológica, ISSN 2254-2884, Vol. 28, Nº. 4, 2025, págs. 302-308
• Idioma: español
• DOI: 10.37551/S2254-28842025030
• Títulos paralelos:
  • Maturation of native arteriovenous fistulas: influence of inflammatory, biochemical and haematological factors
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  • Texto completo
• Resumen
  • español

    Objetivo: Determinar los factores inflamatorios, bioquímicos y hematológicos pre-quirúrgicos y post-quirúrgicos que influyen en la maduración de las fistulas arteriovenosas nativas .

    Material y Método: Estudio observacional retrospectivo. Se realizaron dos analíticas sanguíneas, pre-quirúrgica y post-quirúrgica, analizando parámetros bioquímicos, hematológicos, e inflamatorios. Análisis estadístico: Descriptivo. T-Student, U de Mann-Whitney y Chi cuadrado. Prueba de Wilcoxon y regresión logística binomial.

    Resultados: Muestra de 130 pacientes, edad media 68,3 años. 75,3% hombres. 75,3% fístulas maduras. Al comparar las fístulas maduras frente a las no maduras observamos: Analítica pre-quirúrgica: albumina (p=0,012) y PO2 (p=0,007) significativamente mayores, y PCR (p=0.006) significativamente menor en fístulas maduras. Analítica post-quirúrgica: PCR (p=0.004) y creatinina (p=0,002) significativamente menores en fístulas maduras. Análisis de muestras apareadas: en fístulas maduras: incremento significativo de PO2 (p=0,049), leucocitos (p=0,021) y neutrófilos (p=0,011) post-quirúrgicos, y descenso significativo de PCO2 (p=0,042) y creatinina (p<0,001) post-quirúrgicas. En fístulas no maduras: descenso significativo de albumina pre-quirúrgica (p<0,001). Regresión logística: a mayor valor pre-quirúgico de albumina (OR:0,15;p=0,003) y PO2 (OR:0,54;p=0,002) menor riesgo de fallos de maduración. A mayores valores pre-quirúrgicos de ácido úrico (OR:1,58; p=0,005), y post-quirúrgicos de PCR (OR:1,31; p=0,047) y creatinina (OR:1.22; p=0,006) mayor riesgo de fallos de maduración.

    Conclusiones: Valores elevados de ácido úrico, creatinina y PCR aumentan el riesgo de fallos de maduración; una mayor albúmina y P02 pre-quirúrgicas lo reducen. Tras la cirugía, en fístulas maduras se observa un incremento de PO2, leucocitos y neutrófilos, y un descenso significativo de PCO2 y creatinina.

  • English

    Objective: To determine the preoperative and postoperative inflammatory, biochemical, and haematological factors that influence the maturation of native arteriovenous fistulas.

    Material and Method: We conducted a retrospective observational study. Two blood tests were performed—pre- and postoperative—analysing biochemical, haematological, and inflammatory parameters. Statistical analysis included descriptive statistics, Student’s t test, Mann–Whitney U test, chi-square test, Wilcoxon test, and binomial logistic regression.

    Results: The sample comprised 130 patients with a mean age of 68.3 years; 75.3% were men. Overall, 75.3% of fistulas matured. When comparing mature versus non-mature fistulas, the following findings were observed: Preoperative analysis: albumin (p=0.012) and PO2 (p=0.007) were significantly higher, and C-reactive protein (CRP) (p=0.006) was significantly lower in mature fistulas. Postoperative analysis: CRP (p=0.004) and creatinine (p=0.002) were significantly lower in mature fistulas. Paired-sample analysis: in mature fistulas, there was a significant postoperative increase in PO2 (p=0.049), leukocytes (p=0.021), and neutrophils (p=0.011), and a significant postoperative decrease in PCO2 (p=0.042) and creatinine (p<0.001). In non-mature fistulas, a significant decrease in preoperative albumin was observed (p<0.001). Logistic regression: higher preoperative albumin (OR, 0.15; p=0.003) and PO2 (OR, 0.54; p=0.002) were associated with a lower risk of maturation failure. Higher preoperative uric acid (OR, 1.58; p=0.005), and higher postoperative CRP (OR, 1.31; p=0.047) and creatinine (OR, 1.22; p=0.006) were associated with a greater risk of maturation failure.

    Conclusions: Elevated uric acid, creatinine, and CRP levels increase the risk of fistula maturation failure, whereas higher preoperative albumin and PO2 reduce this risk.

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