Inflammation, oxidation and venous neointimal hyperplasia precede vascular injury from AVF creation in CKD patients

PurposeIntimal hyperplasia (IH), a well-recognized cause of dialysis vascular access failure, is generally believed to be an acquired pathologic lesion. Recent data suggests that IH is present prior to AVF creation. We sought to determine whether pre-existing inflammation and oxidation co-exist with IH prior to their incorporation into an AVF conduit, as their presence may predispose the AVF to further IH following AVF creation.MethodsAt the time of first AV access surgery, vein segments were collected from ten Stage 4 and 5 CKD patients undergoing AVF creation 6–12 months prior to anticipated dialysis initiation. Morphometry and immunohistochemistry was performed to detect inflammatory markers IL-6, TGF-β1, and TNFa, and markers of DNA oxidative damage (8-Hydroxy-2'-deoxyguanosine [HNE]) and lipid peroxidation (4-Hydroxy-2-Nonenal [8OHdG]).ResultsThe degree of IH severity was variable. IL-6, TGF-β1, and TNFa co-localized with a-smooth muscle actin prominently within the venous intima and media. Although ...