The Association Of Klotho G-395A Gene Polymorphism And Autogenous Arteriovenous Fistula Dysfunction In Maintenance Hemodialysis Patients

Objective:To investigate the correlation between klotho G-395A gene polymorphism and autologous arteriovenous fistula failure in maintenance hemodialysis patientsMethods:This prospective study included 198 cases of maintenance dialysis patients undergoing radial-cephalic fistula surgery at Subei People's Hospital from January 2015 to January 2018.The single-nucleotide polymorphisms at the Klotho G-395A site in blood were detected by one-generation sequencing,and the serum klotho protein and FGF23 levels were detected by an enzyme-linked immunosorbent assay.The general and clinical biochemical data of all patients were collected and the service life of patients with arteriovenous fistula were calculated.Cervical vascular color Doppler ultrasound was used to evaluate the atherosclerosis degree of MHD patients,and they were divided into internal fistula failure group and patency group based on bilateral upper limb vascular color Doppler ultrasound and clinical physical examination.The genotype distribution of the failure group and the unobstructed group and the differences between the two groups of klotho protein,FGF23 and clinical biochemical indicators were compared.Cox regression analysis was used to explore the related factors of AVF service life.Results:? As of December 2019,5 of the 198 patients were lost to follow-up(2.5%)and 3 died(1.5%).A total of 190 patients were included in the final analysis,of which 73 had internal fistula failure(38.4%).Fistulas remained unblocked in 117(61.6%).The genotype frequency of G-395A in the study population was 104 GG(54.7%),76 GA(40.0%),and 10 AA(5.3%).There was a Klotho gene G-395A polymorphism distribution.? The 1-year and 2-year survival rates of AVF were 88.9%and 77.8%,respectively.The causes of failure included 31 cases(42.5%)of vascular stenosis,18 cases(24.7%)of thrombosis,10 cases(13.7%)of acute occlusion,and arteries.There were 8 cases(10.9%)of tumors and 6 cases(8.2%)of internal fistula infection.? The univariate analysis of influencing factors of AVF failure showed statistically significant differences in temporary catheterization dialysis,glycated hemoglobin,carotid sclerosis,genotype,RDW-CV and FGF23(P<0.05).? There was a statistical difference in the frequency of the A allele between the dysfunction group and the unblocked group.The A allele frequency of the dysfunction group was higher than that of the unblocked group(P=0.003).? There is a statistically significant difference in klotho protein levels between patients with GG genotype and GA+AA genotype(P=0.015).In terms of gender,age,BMI,smoking history,diabetes history,temporary catheter dialysis,carotid sclerosis history,glycation There were no statistical differences in hemoglobin,hypoalbuminemia,hyperlipidemia,blood phosphorus,blood calcium,PTH,DD polymer,RDW-CV,intubation time,and FGF23 level(P>0.05).? In the analysis of the multi-factor Cox proportional hazard model,genotype,temporary catheter dialysis,and FGF23 are risk factors that affect the long-term patency of AVF.Conclusion:Klotho gene G-395A polymorphism may be related to long-term unobstructed autologous arteriovenous fistula in patients with MHD.The A allele may be an independent risk factor for AVF failure.Klotho protein and FGF23 levels may be related to AVF failure in MHD patients.