Predictive value of serum Krüppel-like factor 2 and angiotensin Ⅱ receptor-like 1 endogenous ligand 13 in hemodialysis patients with autogenous arteriovenous endovascular fistula stenosis

Wang Mingbo; Ni Xiaona; Zhu Lin; Yu Shanshan

doi:10.3760/j.issn.1673-4777.2024.01.017

Abstract：Objective To investigate the predictive value of serum Kruppel-like factor 2(KLF2)and angiotensin Ⅱ receptor-like 1 endogenous ligand 13(Apelin-13)levels in autologous arteriovenous endovascular fistula(AVF)stenosis in hemodialysis patients.Methods Totally 214 hemodialysis patients with AVF as vascular access admitted to Jinan City People's Hospital,Shandong Province from June 2018 to December 2022 were selected as hemodialysis group.Another 53 physically healthy people were selected as control group during the same period.The hemodialysis group was divided into stenosis group(37 cases)and non-stenosis group(177 cases)according to whether they were accompanied by AVF stenosis.Clinical data of patients were recorded.Serum KLF2 and Apelin-13 levels were measured by enzyme-linked immunosorbent assay.Multivariate Logistic regression was used to analyze the factors influencing AVF stenosis in hemodialysis patients and the predictive value of serum KLF2 and Apelin-13 levels on AVF stenosis in hemodialysis patients was analyzed by receiver operating characteristic(ROC)curve.Results Serum KLF2 and Apelin-13 levels were lower in the hemodialysis group than those in the control group(both P＜0.001).The age,dialysis age,proportion of hypotension in dialysis,ultrafiltration rate and low-density lipoprotein cholesterol level in the stenosis group were greater/longer/higher than those in the non-stenosis group,and body mass index,systolic blood pressure,KLF2,Apelin-13 levels were lower than those in the non-stenosis group(all P＜0.05).Multivariate Logistic regression analysis showed that extended dialysis age,hypotension in hemodialysis,and increased ultrafiltration rate were independent risk factors for AVF stenosis in hemodialysis patients,while increased body mass index,elevated KLF2,and elevated Apelin-13 were independent protective factors(all P＜0.05).ROC curve analysis showed that the area under the curve for serum KLF2 and Apelin-13 levels alone and in combination to predict AVF stenosis in hemodialysis patients was 0.797,0.794 and 0.907,with sensitivities of 54.05％,100.00％and 91.89％,and specificities of 92.66％,50.85％and 83.05％,respectively.Conclusion Decreased serum KLF2 and Apelin-13 levels are closely associated with AVF stenosis in hemodialysis patients and can be used as auxiliary predictors of AVF stenosis.