JCCVS
Journal of Cardiology & Cardiovascular Surgery

Journal of Cardiology & Cardiovascular Surgery scientific, open-access, double-blind peer-reviewed journal covering a wide spectrum of topics in cardiology and cardiovascular surgery.

eISSN: 2980-1397
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
The effect of hematological tests on fistula maturation in end-stage renal disease patients with radiocephalic arteriovenous fistula
Abstract
Aims: Arteriovenous fistulas (AVF) are the most commonly used vascular access route for hemodialysis (HD) in patients with end-stage renal disease. The most significant cause of AVF dysfunction is stenosis and post-stenotic thrombosis. Fistula stenosis arises from neointimal hyperplasia and various inflammatory factors. Several inflammatory markers have been studied in relation to AVF loss. This study aims to provide a comprehensive perspective on this globally prevalent health issue by examining the association between the continuity of surgically created AVFs and the patients' clinical factors, inflammatory markers, and biochemical parameters.
Methods: A total of 146 patients were included in the study. All patients underwent preoperative examination of the upper extremity arterial and venous systems to confirm normal circulation. Patients with suitable arterial and venous structures underwent radiocephalic AVF creation at the wrist level. AVFs that achieved adequate flow and allowed for HD were considered matured.
Results: Of the patients, 83 were male and 63 were female. The mean age of the patient group was 58.9 ± 11.41 years, with a minimum age of 30 and a maximum of 77 years. Male sex, low body mass index (BMI), antiplatelet use, and low neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width (RDW) values were positively associated with AVF maturation. However, age, smoking status, type of anesthesia, diabetes, hypertension, and other blood parameters were not significantly associated with AVF maturation.
Conclusion: Our study demonstrated that low maturation rates of AVFs were associated with high NLR and RDW values. In addition, antiplatelet use, male sex, and low BMI were found to be associated with AVF maturation.

Keywords : Arteriovenous fistula, fistula maturation, inflammation

Download Article


1. Annual Data Report. USRDS. https://usrds-adr.niddk.nih.gov/. Accessed July 22, 2025.
2. Rooijens PPGM, Tordoir JHM, Stijnen T, et al. Radiocephalic wrist arteriovenous fistula for hemodialysis: meta-analysis indicates a high primary failure rate. Eur J Vasc Endovasc Surg. 2004;28(6):583-589. doi: 10.1016/j.ejvs.2004.08.014
3. Roy-Chaudhury P, Sukhatme VP, Cheung AK. Hemodialysis vascular access dysfunction: a cellular and molecular viewpoint. J Am Soc Nephrol. 2006;17(4):1112-1127. doi:10.1681/ASN.2005050615
4. Hayashi R, Huang E, Nissenson AR. Vascular access for hemodialysis. Nat Clin Pract Nephrol. 2006;2(9):504-513. doi:10.1038/ncpneph0239
5. Stolic R. Most important chronic complications of arteriovenous fistulas for hemodialysis. Med Princ Pract. 2013;22(3):220-228. doi:10. 1159/000343669
6. Bojakowski K, Dzabic M, Kurzejamska E, et al. A high red blood cell distribution width predicts failure of arteriovenous fistula. PLoS One. 2012;7(5):e36482. doi:10.1371/journal.pone.0036482
7. Bashar K, Zafar A, Ahmed K, et al. Can a neutrophil-lymphocyte ratio derived from preoperative blood tests predict arteriovenous fistula maturation? Ann Vasc Surg. 2016;35:60-67. doi:10.1016/j.avsg.2016.02.020
8. Lee T, Barker J, Allon M. Tunneled catheters in hemodialysis patients: reasons and subsequent outcomes. Am J Kidney Dis. 2005;46(3):501-508. doi:10.1053/j.ajkd.2005.05.024
9. Chiulli LC, Vasilas P, Dardik A. Superior patency of upper arm arteriovenous fistulae in high risk patients. J Surg Res. 2011;170(1):157-164. doi:10.1016/j.jss.2011.03.042
10. Mozaffar M, Fallah M, Lotfollahzadeh S, et al. Comparison of efficacy of side to side versus end to side arteriovenous fistulae formation in chronic renal failure as a permanent hemodialysis access. Nephrourol Mon. 2013;5(3):827-830. doi:10.5812/numonthly.10248
11. Schinstock CA, Albright RC, Williams AW, et al. Outcomes of arteriovenous fistula creation after the Fistula First Initiative. Clin J Am Soc Nephrol. 2011;6(8):1996-2002. doi:10.2215/CJN.11251210
12. Al-Jaishi AA, Oliver MJ, Thomas SM, et al. Patency rates of the arteriovenous fistula for hemodialysis: a systematic review and meta-analysis. Am J Kidney Dis. 2014;63(3):464-478. doi:10.1053/j.ajkd.2013. 08.023
13. Irish A, Dogra G, Mori T, et al. Preventing AVF thrombosis: the rationale and design of the Omega-3 fatty acids (Fish Oils) and aspirin in vascular access outcomes in renal disease (FAVOURED) study. BMC Nephrol. 2009;10:1. doi:10.1186/1471-2369-10-1
14. Lazarides MK, Georgiadis GS, Antoniou GA, Staramos DN. A meta-analysis of dialysis access outcome in elderly patients. J Vasc Surg. 2007; 45(2):420-426. doi:10.1016/j.jvs.2006.10.035
15. Pisoni RL, Young EW, Dykstra DM, et al. Vascular access use in Europe and the United States: results from the DOPPS. Kidney Int. 2002;61(1): 305-316. doi:10.1046/j.1523-1755.2002.00117.x
16. Lok CE, Oliver MJ, Su J, Bhola C, Hannigan N, Jassal SV. Arteriovenous fistula outcomes in the era of the elderly dialysis population. Kidney Int. 2005;67(6):2462-2469. doi:10.1111/j.1523-1755.2005.00355.x
17. Swindlehurst N, Swindlehurst A, Lumgair H, et al. Vascular access for hemodialysis in the elderly. J Vasc Surg. 2011;53(4):1039-1043. doi:10. 1016/j.jvs.2010.09.068
18. Weale AR, Bevis P, Neary WD, et al. Radiocephalic and brachiocephalic arteriovenous fistula outcomes in the elderly. J Vasc Surg. 2008;47(1):144-150. doi:10.1016/j.jvs.2007.09.046
19. Astor BC, Coresh J, Powe NR, Eustace JA, Klag MJ. Relation between gender and vascular access complications in hemodialysis patients. Am J Kidney Dis. 2000;36(6):1126-1134. doi:10.1053/ajkd.2000.19816
20. Sedlacek M, Teodorescu V, Falk A, Vassalotti JA, Uribarri J. Hemodialysis access placement with preoperative noninvasive vascular mapping: comparison between patients with and without diabetes. Am J Kidney Dis. 2001;38(3):560-564. doi:10.1053/ajkd.2001.26873
21. Konner K, Hulbert-Shearon TE, Roys EC, Port FK. Tailoring the initial vascular access for dialysis patients. Kidney Int. 2002;62(1):329-338. doi: 10.1046/j.1523-1755.2002.00436.x
22. Kordzadeh A, Chung J, Panayiotopoulos YP. Cephalic vein and radial artery diameter in formation of radiocephalic arteriovenous fistula: a systematic review. J Vasc Access. 2015;16(6):506-511. doi:10.5301/jva. 5000413
23. Aronson D, Bloomgarden Z, Rayfield EJ. Potential mechanisms promoting restenosis in diabetic patients. J Am Coll Cardiol. 1996;27(3): 528-535. doi:10.1016/0735-1097(95)00496-3
24. Marrone D, Pertosa G, Simone S, et al. Local activation of interleukin 6 signaling is associated with arteriovenous fistula stenosis in hemodialysis patients. Am J Kidney Dis. 2007;49(5):664-673. doi:10. 1053/j.ajkd.2007.02.266
25. Conte MS, Nugent HM, Gaccione P, Roy-Chaudhury P, Lawson JH. Influence of diabetes and perivascular allogeneic endothelial cell implants on arteriovenous fistula remodeling. J Vasc Surg. 2011;54(5): 1383-1389. doi:10.1016/j.jvs.2011.05.005
26. Dammers R, Tordoir JHM, Kooman JP, et al. The effect of flow changes on the arterial system proximal to an arteriovenous fistula for hemodialysis. Ultrasound Med Biol. 2005;31(10):1327-1333. doi:10.1016/ j.ultrasmedbio.2005.03.017
27. Kharboutly Z, Fenech M, Treutenaere JM, Claude I, Legallais C. Investigations into the relationship between hemodynamics and vascular alterations in an established arteriovenous fistula. Med Eng Phys. 2007;29(9):999-1007. doi:10.1016/j.medengphy.2006.10.018
28. Kim JT, Chang WH, Oh TY, Jeong YK. Venous distensibility as a key factor in the success of arteriovenous fistulas at the wrist. Ann Vasc Surg. 2011;25(8):1094-1098. doi:10.1016/j.avsg.2011.05.014
29. Satoh M. Endothelial dysfunction as an underlying pathophysiological condition of chronic kidney disease. Clin Exp Nephrol. 2012;16(4):518-521. doi:10.1007/s10157-012-0646-y
30. Alexander RW. Hypertension and the pathogenesis of atherosclerosis. Hypertension. 1995;25(2):155-161. doi:10.1161/01.HYP.25.2.155
31. Truong A, Hanna MH, Moghadamyeghaneh Z, Stamos MJ. Implications of preoperative hypoalbuminemia in colorectal surgery. World J Gastrointest Surg. 2016;8(5):353-362. doi:10.4240/wjgs.v8.i5.353
32. Farrugia A. Albumin usage in clinical medicine: tradition or therapeutic? Transfus Med Rev. 2010;24(1):53-63. doi:10.1016/j.tmrv. 2009.09.005
33. Churchill DN, Taylor DW, Cook RJ, et al. Canadian hemodialysis morbidity study. Am J Kidney Dis. 1992;19(3):214-234. doi:10.1016/s0272-6386(13)80002-9
34. Chang CJ, Ko YS, Ko PJ, et al. Thrombosed arteriovenous fistula for hemodialysis access is characterized by a marked inflammatory activity. Kidney Int. 2005;68(3):1312-1319. doi:10.1111/j.1523-1755.2005.00529.x
35. Förhécz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohászka Z, Jánoskuti L. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J. 2009; 158(4):659-666. doi:10.1016/j.ahj.2009.07.024
36. Wen Y. High red blood cell distribution width is closely associated with risk of carotid artery atherosclerosis in patients with hypertension. Exp Clin Cardiol. 2010;15(3):37-40.
37. Cardinal H, Raymond MA, Hébert MJ, Madore F. Uraemic plasma decreases the expression of ABCA1, ABCG1 and cell-cycle genes in human coronary arterial endothelial cells. Nephrol Dial Transplant. 2007;22(2):409-416. doi:10.1093/ndt/gfl619
38. Cowan DB, Langille BL. Cellular and molecular biology of vascular remodeling. Curr Opin Lipidol. 1996;7(2):94-100. doi:10.1097/00041433-199604000-00008
39. Landmesser U, Hornig B, Drexler H. Endothelial function: a critical determinant in atherosclerosis? Circulation. 2004;109(21 Suppl 1):II27-33. doi:10.1161/01.CIR.0000129501.88485.1f
40. Bombeli T, Karsan A, Tait JF, Harlan JM. Apoptotic vascular endothelial cells become procoagulant. Blood. 1997;89(7):2429-2442.
41. Schwartz BR, Karsan A, Bombeli T, Harlan JM. A novel beta 1 integrin-dependent mechanism of leukocyte adherence to apoptotic cells. J Immunol. 1999;162(8):4842-4848.
42. Raymond MA, Désormeaux A, Laplante P, et al. Apoptosis of endothelial cells triggers a caspase-dependent anti-apoptotic paracrine loop active on VSMC. FASEB J. 2004;18(6):705-707. doi:10.1096/fj.03-0573fje
43. Pearson JD. Vessel wall interactions regulating thrombosis. Br Med Bull. 1994;50(4):776-788. doi:10.1093/oxfordjournals.bmb.a072925
44. Biuckians A, Scott EC, Meier GH, Panneton JM, Glickman MH. The natural history of autologous fistulas as first-time dialysis access in the KDOQI era. J Vasc Surg. 2008;47(2):415-421. doi:10.1016/j.jvs.2007.10.041
45. Depboylu BC, Külcü N, Yolyapan DA. Retrospective analysis of arteriovenous fistulas for hemodialysis: our two-year clinical experience. Damar Cer Derg. 2014;23(2):67-71. doi:10.9739/uvcd.2014-41105
Article available in :
Volume 3, Issue 3, 2025
Page : 43-49
https://doi.org/10.51271/JCCVS-0057
Article Information
Received : 24 Tem 2025
Accepted : 25 Eyl 2025
Published : 27 Eyl 2025
Corresponding Author :

Halis Yılmaz: Department of Cardiovascular Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkiye

[email protected]
Citation : Yılmaz H, Tuncay A. The effect of hematological tests on fistula maturation in end-stage renal disease patients with radiocephalic arteriovenous fistula. J Cardiol Cardiovasc Surg. 2025;3(3):43-49.

Read: 28
Download : 16
Cited: 0
_Footer