Patency and survival analysis of hemodialysis arteriovenous fistula and influencing factors of fistula dysfunction.

INTRODUCTION

Establishing reliable vascular access is vital for end-stage renal disease (ESRD) patients. This study evaluated autogenous arteriovenous fistula (AVF) patency rates and identified independent factors associated with dysfunction to optimize postoperative management.

METHODS

We retrospectively analyzed 186 patients undergoing their first AVF creation between 2021 and 2023, with follow-up through July 20, 2025. Statistical methods included multivariate Cox regression (treating Hb and TG as continuous variables), restricted cubic spline (RCS) analysis for non-linear trends, and Fine-Gray competing risk models to differentiate dysfunction subtypes.

RESULTS

The primary patency rates at 6, 12, and 24 months were 85.48%, 79.57%, and 76.34%, respectively. During follow-up, 28.0% (52/186) of patients experienced dysfunction, primarily due to thrombosis (46.2%) and stenosis (34.6%). Multivariate Cox analysis identified relatively higher baseline Hb (HR = 1.017 per 1 g/L increase, 95% CI: 1.001-1.033, p = 0.033) and TG (HR = 1.850 per 1 mmol/L increase, 95% CI: 1.048-3.265, p = 0.034) as independent risk factors. Conversely, larger preoperative vessel diameters and senior surgeon experience served as significant protective factors (p < 0.05). RCS analysis confirmed a near-linear increase in dysfunction risk as Hb levels rose within the ESRD-prevalent range (p for non-linearity = 0.412). ROC analysis yielded AUCs of 0.718 for Hb (cut-off >101.5 g/L) and 0.677 for TG (cut-off >1.915 mmol/L).

CONCLUSION

Relatively higher baseline Hb and TG levels are independently associated with increased AVF dysfunction risk, alongside anatomical and technical determinants. Individualized metabolic monitoring and optimized surgical selection are recommended to enhance fistula longevity.