Examining the Influence of Vascular Access on Malnutrition, Inflammation and Atherosclerosis Syndrome in Hemodialysis: A Cross-sectional Study of Comparison Permcath and Fistula from Southeast Iran

Abstract

Background: End-stage renal disease (ESRD) is characterized by malnutrition-inflammation-atherosclerosis (MIA) syndrome. Objectives: The present study aimed to compare the components of this syndrome between hemodialysis patients using a permcath and those using a fistula, focusing on how vascular access affects MIA syndrome. Methods: This cross-sectional study was conducted from June to August 2022 in two referral hospitals in Southeast Iran. Forty adult hemodialysis patients (≥ 18 years) with ESRD undergoing dialysis for at least six months were enrolled, divided equally into two groups based on vascular access type: Twenty individuals dialyzed using a permcath and twenty individuals using a fistula. The sample size was determined based on the exploratory nature of the research and the available patient population during the recruitment period. Malnutrition was assessed through serum albumin and Body Mass Index (BMI) measurements. Inflammatory markers, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell (WBC) count, and serum ferritin levels, were evaluated to detect inflammation. Atherosclerosis was estimated by assessing mean carotid intima-media thickness (mean-CIMT), atherosclerotic plaques, and lipid profile parameters. Hypoalbuminemia was defined as serum albumin < 3.5 g/dL, and a mean CIMT > 1 mm was considered indicative of subclinical atherosclerosis. Potential confounders such as age, sex, primary kidney disease, and dialysis duration were considered. Statistical analyses included independent t-tests, Mann-Whitney U tests, and chi-square/Fisher’s exact tests, with a significance threshold of P < 0.05. Efforts were made to minimize bias by standardizing laboratory assessments, blinding radiologists to patient data, and ensuring comparable baseline characteristics between the groups. Results: Similar demographic and clinical characteristics were observed between the two groups. Among the malnutrition parameters, albumin levels differed significantly between the permcath and fistula groups (P = 0.03), while BMI showed no significant difference (P ≥ 0.05). Inflammation parameters were similar between the groups, with no significant differences observed (P ≥ 0.05). In terms of atherosclerosis, 30% of the permcath group had a high mean CIMT (> 1 mm) compared to none in the fistula group, demonstrating a significant difference (P = 0.008). However, unilateral and bilateral atherosclerotic plaques and serum triglyceride and cholesterol levels showed no statistically significant differences between the two groups (P ≥ 0.05). Conclusions: While both methods showed similar inflammatory profiles, hemodialysis using a fistula was associated with better nutritional status and a lower risk of atherosclerosis compared to permcath. These findings suggest that fistula-based hemodialysis may be preferable for reducing the risk of malnutrition and early atherosclerotic changes in ESRD patients.