Arteriovenous fistulas and digital hypoperfusion ischemic syndrome in patients on hemodialysis.

Aim: To determine survival parameters as well as characteristics of patients with this syndrome.
Methods: The investigation was conducted over a period of eight years, as a prospective, non-randomized, clinical study which included 204 patients, treated by chronic hemodialysis. Most patients received hemodialysis 12 h per week. As vascular access for hemodialysis all subjects had an arteriovenous fistulae. Based on surveys the respondents were divided into groups of patients with and without digital hypoperfusion ischemic syndrome. Gender, demographic and anthropometric characteristics, together with comorbidity and certain habits, were recorded. During this period 34.8% patients died.
Results: Patients with digital hypoperfusion ischemic syndrome were older than those without ischemia (P = 0.01). Hemodialysis treatment lasted significantly longer in the patients with digital hypoperfusion ischemic syndrome (P = 0.02). The incidence of cardiovascular disease (P < 0.001) and diabetes mellitus (P = 0.01), as well as blood flow through the arteriovenous fistula (P = 0.036), were higher in patients with digital hypoperfusion ischemic syndrome. Statistically significant differences also existed in relation to oxygen saturation (P = 0.04). Predictive parameters of survival for patients with digital hypoperfusion ischemic syndrome were: adequacy of hemodialysis (B = -3.604, P < 0.001), hypertension (B = -0.920, P = 0.018), smoking (B = -0.901, P = 0.049), diabetes mellitus (B = 1.227, P = 0.005), erythropoietin therapy (B = 1.274, P = 0.002) and hemodiafiltration (B = -1.242, P = 0.033). Kaplan-Meier survival analysis indicated that subjects with and without digital hypoperfusion ischemic syndrome differed regarding the length of survival (P < 0.001), i.e., patients with confirmed digital hypoperfusion ischemic syndrome died earlier.
Conclusion: Survival was significantly longer in the patients without digital hypoperfusion ischemic syndrome.