Association between preoperative C-reactive protein to albumin ratio and late arteriovenous fistula dysfunction in hemodialysis patients: A cohort study

Abstract

Abstract Arteriovenous fistula (AVF) dysfunction in hemodialysis (HD) patients is linked to high mortality and inflammation may play a role. We investigated the association between CAR and AVF dysfunction in a group of HD patients from China. We conducted a retrospective cohort study of 695 adults with end-stage renal disease (ESRD) receiving new AVF placement at a single center between 2011 and 2019. Multivariable Cox regression was used to examine the potential association between preoperative CAR and AVF dysfunction, defined as surgical or transluminal angioplasty intervention due to thrombosis or significant vessel diameter reduction. Among 695 HD patients with a new AVF, 212 (30.5%) experienced dysfunction during a median follow-up of 33 months. Adjusted multivariable Cox regression analysis found that a one-unit increase in CAR was associated with a 28% higher risk of AVF dysfunction. Those with CAR ≥ 0.146 had a 76% increased risk compared to those with CAR values between 0.035 and 0.146. The relationship between CAR and AVF dysfunction varied by placement site of internal jugular vein catheters, with significantly higher hazard ratios for ipsilateral placement. The interaction between CAR and catheter placement site was also significant (p-value: 0.004). Our study findings indicate that higher preoperative CAR is linked to an increased likelihood of AVF dysfunction in Chinese patients undergoing HD, especially when ipsilateral internal jugular vein catheters are placed. These results provide valuable insights for clinicians in identifying high-risk patients for AVF dysfunction.