Risk factors and risk prediction model construction for restenosis after percutaneous transluminal angioplasty in hemodialysis patients with arteriovenous fistula stenosis
Objective To explore the risk factors of restenosis after percutaneous transluminal angioplasty(PTA)for pa-tients with arteriovenous fistula(AVF)stenosis during hemodialysis and construct of a risk prediction model.Methods Retrospective analysis of clinical data from 208 patients with hemodialysis AVF stenosis who underwent PTA treatment in the Renal Rheumatology and Immunology Department of the Third People's Hospital of Zhengzhou from Jan-uary 1,2020 to June 30,2022.Patients were followed up for 12 months after surgery,and were divided into two groups based on whether AVF stenosis occurred again after PTA:the occurrence group and the non occurrence group.Single factor and multiple factor logistic regression analysis models were used to screen for risk factors affecting restenosis after PTA in hemodialysis AVF stenosis.Bootstrap self sampling method and C-index were used to validate the model internal-ly.Results Among 208 hemodialysis patients with AVF stenosis,66 cases(31.73％)experienced AVF restenosis after PTA.Univariate analysis showed that the incidence of type 2 diabetes mellitus(T2DM,x2=67.848,P＜0.001),hypo-magnesemia(x2=44.044,P＜0.001),and the calcium phosphorus product(t=16.049,P＜0.001)were higher in the re-stenosis group than in the non occurring group,and the differences were statistically significant.The results of multi-variate logistic analysis showed that concomitant T2DM(OR=6.944,95％CI was 1.591-30.305,P=0.010),concom-itant hypomagnesemia(OR=5.889,95％CI was 1.179-29.529,P=0.031),and high calcium phosphorus product(OR=3.366,95％CI was 2.232-5.075,P＜0.001)were risk factors for restenosis in hemodialysis AVF stenosis pa-tients after PT A.Based on the results of multivariate logistic regression analysis,a risk prediction column chart model for restenosis after PTA in hemodialysis AVF stenosis was constructed.Bootstrap self sampling method and C-index were used to internally validate the above model(C-index=0.890).The accuracy and discrimination of the column chart were good,and the calibration curve fitted well with the ideal curve.Conclusions The risk factors for restenosis after PTA in hemodialysis AVF stenosis patients may include concomitant T2DM,concomitant hypomagnesemia,and high calcium phosphorus product.The column chart model established based on this has good predictive efficacy for the risk of resteno-sis after PTA in hemodialysis AVF stenosis patients.
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