Nutritional-metabolic indicators do not independently predict AVF thrombosis after adjustment for surgical frequency: a retrospective cohort study

作者：Peng Shu, Zhuping Wen, Yiqi Luo, Xingruo Zeng, Fang Xu · 发表于：Frontiers in Nutrition · 年份：2026 · DOI：10.3389/fnut.2026.1845230 · 研究领域：Central Venous Catheters and Hemodialysis、Peripheral Artery Disease Management、Venous Thromboembolism Diagnosis and Management

Background Arteriovenous fistula (AVF) thrombosis is a leading cause of vascular access failure in hemodialysis patients. Although nutritional status is often hypothesized to influence thrombotic risk, most previous studies have not accounted for surgical burdens such as repeated surgical procedures. This study assessed whether common nutritional and metabolic markers are independently associated with AVF thrombosis after adjustment for surgical frequency. Methods This retrospective cohort study included 783 patients who underwent AVF creation between January 2017 and October 2024. Nutritional and metabolic markers were defined using standard formulas. Missing data were handled using multiple imputation. Candidate predictors were identified through univariate analysis ( p < 0.20). Multivariate logistic regression was initially performed, followed by Cox proportional hazards regression as the primary analysis to properly account for variable follow-up durations. Model discrimination was assessed by the area under the receiver operating characteristic curve (AUC), calibration by the Hosmer-Lemeshow test, and clinical utility by decision curve analysis. Subgroup and sensitivity analyses were performed. Results Among 783 patients (median follow-up 34 months), 96 (12.3%) developed AVF thrombosis. Cumulative surgical burden was the strongest independent risk marker (hazard ratio [HR] = 1.44, 95% CI: 1.28–1.62, p < 0.001). Hypertension showed a borderline association (...