Elevated plasma D-Dimer level as a risk factor for immaturity of autogenous arteriovenous fistula

Abstract

This study aimed to identify risk factors associated with immature arteriovenous fistula (AVF) in diabetic patients and assist medical professionals in preemptively managing AVFs with a high risk of suboptimal maturity, even in the perioperative period or earlier. Based on the occurrence of poor maturation during the study period (June 2019 to June 2024), 185 patients were categorized into two groups: immature AVF (n=52) and mature AVF (n=133). Multivariate logistic regression analyses were executed to examine the influence of demographic, biochemical, and imaging indicators on the maturation status of AVF among diabetic patients. Univariate analysis indicated significant disparities in total cholesterol (TC; OR: 0.57, 95%CI: 0.42-1.76, P<0.001), internal cephalic vein meridian (ICVM; OR: 0.35, 95%CI: 0.20-0.63, P<0.001), plasma D-D (OR: 1.23, 95%CI: 1.05-1.44, P=0.01), and radial artery plaque (RAP; OR: 2.62, 95%CI: 1.15-5.99, P<0.022) between the mature and immature AVF groups. The multivariate logistic regression analysis further confirmed that TC (OR: 0.56, 95%CI: 0.41-0.77, P<0.001), ICVM (OR: 0.34, 95%CI: 0.18-0.66, P=0.001), and D-D (OR: 1.25, 95%CI: 1.04-1.49, P=0.017) were independently predictive of immature AVF in diabetic patients. The results of the restricted cubic spline curve analysis revealed a nonlinear association between D-D levels and the immaturation AVF (P for nonlinearity=0.166). Our findings preliminarily suggest a possible correlation between elevated plasma D-D levels in diabetic patients and the occurrence of immature AVF.