Risk factors associated with long-term radio-cephalic arteriovenous fistula failure in dialysis patients

Adrian Vasile Muresan; Réka Bartus; Emil Marian Arbănași; Eliza Mihaela Arbănași; Alexandru Ludovic Szanto; Elena Florea; Cătălin Mircea Coșarcă; Marius Mihai Harpa; Ioan Hosu; Claudiu Constantin Ciucanu; Nicoale Alexandru Lazăr; Ionela Georgiana Bodiu; Eliza Russu

doi:10.2478/amma-2025-0001

Adrian Vasile Muresan Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
Réka Bartus Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
Emil Marian Arbănași Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania; Regenerative Medicine Laboratory, Centre for Advanced Medical and Pharmaceutical Research (CCAMF), George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
Eliza Mihaela Arbănași Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania; Regenerative Medicine Laboratory, Centre for Advanced Medical and Pharmaceutical Research (CCAMF), George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540139 Targu Mures, Romania
Alexandru Ludovic Szanto Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
Elena Florea Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
Cătălin Mircea Coșarcă Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
Marius Mihai Harpa Emergency Institute for Cardiovascular Diseases and Transplantation Targu Mures, 540136 Targu Mures, Romania Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540142 Targu Mures, Romania
Ioan Hosu Department of Nephrology, Mures County Emergency Hospital, 540136 Targu Mures, Romania
Claudiu Constantin Ciucanu Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
Nicoale Alexandru Lazăr Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
Ionela Georgiana Bodiu Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
Eliza Russu Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania

DOI: https://doi.org/10.2478/amma-2025-0001

Keywords: leukocyte glucose index, vascular surgery, arteriovenous fistula, dialysis, interleukin-6

Abstract

Objective: The aim of this study is to analyze the risk factors associated with long-term radio-cephalic arteriovenous fistula failure in dialysis patients.

Methods: This retrospective observational study enrolled 81 patients diagnosed with end-stage kidney disease requiring arteriovenous fistula. Patients were categorized into two groups based on the long-term permeability of vascular access. The hospital's electronic database was used to collect demographic data, risk factors, comorbidities, pre-operative laboratory data, and pre-operative vascular mapping characteristics.

Results: Among the patients with arteriovenous fistula failure, we observed a lower incidence of men (p=0.009), a higher incidence of diabetes mellitus (p=0.036), and a higher incidence of active smoking (p=0.009). At ROC-curve analysis we identified an optimal cut-off value of 128.2 for glucose (AUC: 0.715, 66.7% Sensitivity, and 78.1% Specificity), 1.17 for leukocyte glucose index (AUC: 0.692, 60.0% Sensitivity, and 81.2% Specificity), and 7.33 for interleukin-6 (AUC: 0.925, 90.0% Sensitivity, and 84.6% Specificity). In Kaplan-Meier survival curve analysis, there was a higher incidence of arteriovenous fistula failure among females (p=0.033), smokers (p<0.001), and patients undergoing hemodialysis via a central venous catheter at the time of admission (p=0.047). Cox-regression analysis indicates that female sex (HR: 3.43, p=0.033) and active smoking (HR: 5.02, p=0.002) are predictors of vascular access dysfunction. Additionally, elevated values of glucose (HR: 1.89, p=0.004), Interleukin-6 (HR: 2.78, p=0.001), and leukocyte glucose index (HR: 1.95, p=0.008) are associated with arteriovenous fistula failure.

Conclusions: In conclusion, female sex, active smoking, high baseline glucose levels, Interleukin-6, and leukocyte glucose index are linked to long-term failure of arteriovenous fistula failure.

Risk factors associated with long-term radio-cephalic arteriovenous fistula failure in dialysis patients

Risk factors associated with long-term RC-AVF failure

Abstract