Analysis Of Influencing Factors For Arteriovenous Fistula Dysfunction In Maintenance Hemodialysis Patients

Research Background:Arteriovenous fistula(AVF)is the primary vascular access type for maintenance hemodialysis(MHD)patients in China.As the lifeline for hemodialysis patients,the vascular access serves as the medium for blood purification.However,research has shown that the one-year natural patency rate of AVF is only 60%.Dysfunction of AVF can lead to inadequate dialysis and is the most common reason for secondary interventions and readmissions,posing a threat to patients’ health and increasing their economic burden.Loss of work in arteriovenous fistula has been reported to be associated with a variety of factors,several studies have demonstrated a correlation between inflammatory markers and AVF dysfunction.Blood cell ratios,such as the platelet-to-lymphocyte ratio(PLR),neutrophil-to-lymphocyte ratio(NLR),and monocyte-to-lymphocyte ratio(MLR),have been reported as novel,easily obtainable,and reproducible inflammatory markers.They have been associated with the occurrence,severity,and prognosis of cardiovascular and cerebrovascular diseases,as well as venous thrombosis formation,reflecting the degree of systemic low-grade inflammation.These ratios may play a role in predicting AVF dysfunction.This study focuses on the correlation between blood cell ratios and the occurrence of AVF dysfunction,providing a basis for implementing preventive measures against AVF dysfunction.Research Method:A total of 761 patients who underwent AVF surgery and received regular hemodialysis at the Nephrology Department of Lequn Campus,Jilin University First Hospital,from September 2020 to September 2022 were retrospectively collected through electronic medical records.These patients were divided into two groups based on the patency of the AVF: the AVF patent group(639 cases)and the AVF dysfunction group(122 cases).Differences between the two groups in terms of age,gender,smoking history,alcohol consumption history,comorbidities,and primary diseases were analyzed using chi-square tests,t-tests,or rank sum tests.Univariate and multivariate Cox regression analyses were performed to verify the impact of diabetic nephropathy on the occurrence of AVF dysfunction.Multiple regression equations were used to assess the predictive ability of blood cell counts and ratios for predicting AVF dysfunction in patients undergoing MHD.Collinearity screening was conducted on all covariates before establishing the regression equations,and the variance inflation factor for all covariates was found to be less than 5.To adjust for confounding factors,three regression models were established.Model 1 was unadjusted,while model 2 adjusted for demographic information,including gender and age.In model 3,all risk factors contributing to dysfunction were selected,including age,history of hypertension,history of diabetes,history of coronary heart disease,diabetic nephropathy,AST,GLU,HB,and HCT.Receiver operating characteristic(ROC)curves were plotted,and the area under the curve(AUC)was calculated to evaluate the predictive ability of blood cell ratios for AVF dysfunction.The optimal threshold was determined based on the AUC.The predictive ability of the optimal threshold for AVF dysfunction was further validated using a multivariate Cox regression equation.Data analysis was performed using R software(http://www.r-project.org;version 3.4.3)and Empower Stats software(http://www.empowerstats.com).Statistical significance was set at P < 0.05.Research Results:1.Compared to patients with the primary disease of chronic glomerulonephritis as the baseline control,the results of univariate Cox regression analysis indicated that diabetic nephropathy increases the risk of AVF dysfunction occurrence(HR=2.23,95%CI:1.48-3.36,P=0.0001).There was no difference in the risk of AVF dysfunction occurrence when comparing other types of primary diseases with chronic glomerulonephritis(P>0.05).2.Compared to patients with non-diabetic nephropathy as the primary disease,diabetic nephropathy increases the risk of AVF dysfunction occurrence in MHD patients(HR=2.17,95%CI:1.52-3.09,P<0.0001).Multivariate Cox regression analysis suggested that diabetic nephropathy is an independent risk factor for AVF dysfunction occurrence in MHD patients(HR=1.93,95%CI:1.33-2.79,P=0.0005).3.The age of the AVF dysfunction group was significantly higher than that of the AVF patent group,and the difference between the two groups was statistically significant(P <0.05).Patients in the AVF dysfunction group exhibited higher levels of AST,GLU,HB,and HCT compared to the AVF patent group,and these differences were statistically significant(P < 0.05).4.Cox regression analysis revealed that blood cell ratios can predict the occurrence of AVF dysfunction in MHD patients.After adjusting for confounding factors,the results of multivariate Cox regression analysis indicated that PLR(HR=1.002,95%CI:1.001-1.003,P=0.00040),NLR(HR=1.060,95%CI:1.032-1.088,P=0.00002),and MLR(HR=2.634,95%CI : 1.741-3.983,P=<0.00001)are independent risk factors for AVF dysfunction occurrence in MHD patients.Among them,MLR exhibited more consistent positive results,with a 1-unit increase in MLR associated with a 1.634-fold increased risk of AVF dysfunction occurrence in MHD patients.5.The AUC was calculated using ROC curves,and the optimal threshold for MLR to predict AVF dysfunction occurrence in MHD patients was determined.The reliability of the optimal threshold was further validated through multivariate Cox regression analysis.After adjusting for confounding factors,the results of multivariate Cox regression analysis indicated that MHD patients with MLR greater than 0.595 have a higher risk of AVF dysfunction occurrence compared to patients with MLR less than 0.595(HR=1.923,95%CI:1.301-2.843,P=0.00105).Conclusions:1.Diabetic nephropathy,as the primary disease,is an independent risk factor for AVF dysfunction occurrence in MHD patients.2.The risk of AVF dysfunction in MHD patients increases continuously with age,as well as elevated levels of AST,GLU,HB,and HCT.3.PLR,NLR,and MLR are independent risk factors for AVF dysfunction occurrence in MHD patients,with MLR demonstrating the highest specificity and accuracy.