Assessment of apoptosis in the native vein used for hemodialysis access

Leci-Tahiri, Laura and Krušlin, Božo and Vučić, Majda and Sonicki, Zdenko and Lovričević, Ivo (2016) Assessment of apoptosis in the native vein used for hemodialysis access. Croatian Medical Journal, 57 (6). pp. 540-547. ISSN 0353-9504

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Abstract

AIM: To determine whether apoptosis is more common in previously punctured native veins than in non-punctured native veins among patients who undergo surgical creation of arteriovenous fistula (AVF) for dialysis access. ----- METHODS: Cephalic vein specimens were obtained from January 1, 2013 to December 31, 2014 from 60 patients, 30 with previously punctured native veins and 30 with non-punctured native veins. Before AVF placement, a 1-cm vein segment was excised from distal part of the vein for histological, histochemical, and immunohistochemical analysis. Vein specimens were divided into two portions along the longitudinal axis and stained with hematoxylin and eosin for routine histological evaluation. Immunohistochemical analysis was used to localize Bax, p53, caspase 3, and Bcl-2 expression. ----- RESULTS: The group with previously punctured veins showed significantly increased caspase 3 (P<0.001, two-sided Fisher`s Exact Test) and Bax expression (P=0.002, two-sided Fisher`s Exact Test) and significantly decreased Bcl-2 expression (P<0.001, two-sided Fisher`s Exact Test) compared with the control group. There were no significant differences between the groups in p53 expression (?2=0.071, df=1, P=0.791). Fistula failure was significantly more common in the study group (26.7% vs 6.7%, ?2=4.32, df=1, P=0.038). ----- CONCLUSION: Our study indicates a possible role of venipuncture in apoptosis development and a possible role of apoptosis in fistula failure, but we do not have sufficient evidence to conclude that it represents its main cause.

Abstract in Croatian

Procjena stupnja apoptoze u nativnoj veni korištenoj u svrhu pristupa za hemodijalizu ----- Cilj: Odrediti je li apoptoza češća u nativnim venama koje su prethodno bile punktirane nego u onima koje prethodno nisu bile punktirane među pacijentima kojima je kirurškim putem oblikovana arteriovenska fistula u svrhu pristupa za hemodijalizu. ----- Postupci: Od 1. siječnja 2013. do 31. prosinca 2014. godine prikupili smo uzorke cefalične vene od 60 pacijenata, od kojih je 30 imalo prethodno punktirane nativne vene, a 30 nije imalo prethodno punktirane nativne vene. Prije oblikovanja arteriovenska fistule, iz distalnog dijela vene izrezali smo segment vene dužine 1 cm za histološku, histokemijsku i imunohistokemijsku analizu. Uzorci vene podijeljeni su po longitudinalnoj osi u dva dijela i obojeni hematoksilinom i eozinom kako bismo napravili rutinsku histološku procjenu. Za lokalizaciju izražaja proteina Bax, p53, kaspaze 3 i Bcl-2 koristili smo imunohistokemijsku analizu. ----- Rezultati: Skupina s prethodno punktiranim venama u usporedbi s kontrolnom skupinom imala je značajno povišen izražaj kaspaze 3 (P<0,001, dvostrani Fisherov egzaktni test) i Bax-a (P=0,002, dvostrani Fisherov egzaktni test), te značajno snižen izražaj Bcl-2 (P<0,001, dvostrani Fisherov egzaktni test). Između skupina nije bilo značajne razlike u izražaju p53 (χ2=0,071, df=1, P=0,791). Neuspjeh fistule bio je značajno češći u skupini s prethodno punktiranim venama nego u kontrolnoj skupini (26,7% nasuprot 6.7%, χ2=4,32, df=1, P=0,038). ----- Zaključak: Naše ispitivanje ukazuje na moguću ulogu venepunkcije u razvoju apoptoze te na moguću ulogu apoptoze u neuspjehu fistule, iako ne možemo sa sigurnošću tvrditi da ona predstavlja njegov glavni uzrok.

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