Integrated Impact of Inflammation and Mineral Metabolism on Arteriovenous Fistula Stenosis and Repeated Intervention in Maintenance Hemodialysis: A Real-World Cross- Sectional Study

Integrated Impact of Inflammation and Mineral Metabolism on Arteriovenous Fistula Stenosis and Repeated Intervention in Maintenance Hemodialysis: A Real-World Cross- Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Integrated Impact of Inflammation and Mineral Metabolism on Arteriovenous Fistula Stenosis and Repeated Intervention in Maintenance Hemodialysis: A Real-World Cross- Sectional Study kun yang, Wenxu Pan, Jingzhu Wang, Jiali Liu, Jincheng Tang, Tong Zhou, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9055359/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Arteriovenous fistula (AVF) dysfunction remains a major barrier to adequate dialysis delivery in patients undergoing maintenance hemodialysis (MHD), frequently resulting in repeated interventions and increased healthcare burden. Although chronic inflammation and mineral metabolism abnormalities are both implicated in vascular remodeling, their integrated clinical significance in AVF stenosis has not been well defined. Leveraging large-scale real-world data, this cross-sectional study aimed to comprehensively evaluate the associations of inflammatory indices and calcium–phosphate metabolism parameters with AVF stenosis and repeated percutaneous transluminal angioplasty (PTA). Methods In this single-center cross-sectional study, 683 MHD patients with AVF stenosis requiring PTA were enrolled as the case group, while 255 contemporaneous patients with normally functioning AVFs served as controls. Demographic characteristics, comorbidities, dialysis vintage, laboratory measurements, mineral metabolism markers, and inflammatory indices were collected. Inflammatory markers—including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to–high-density lipoprotein ratio (NHR), and systemic immune-inflammation index (SII)—were derived from peripheral blood counts. Multivariable logistic regression analyses were conducted to identify variables independently associated with AVF stenosis and repeated PTA within 12 months. Discriminatory performance was evaluated using receiver operating characteristic (ROC) curves, with subgroup analyses performed according to diabetes status and sex. Results Patients with AVF stenosis exhibited significantly higher serum phosphorus, intact parathyroid hormone (iPTH), calcium–phosphate product, NLR, PLR, and SII levels, alongside lower LMR and lymphocyte counts (all P < 0.05). Elevated iPTH, NLR, SII, calcium–phosphate product, and diabetes were independently associated with AVF stenosis. Among patients with established stenosis, higher NLR, diabetes, longer dialysis vintage, female sex, and lower serum albumin were independently associated with repeated PTA. Subgroup analyses suggested stronger associations with repeated interventions among diabetic and female patients. Notably, prediction models integrating inflammatory and mineral metabolism markers demonstrated superior discriminatory capacity compared with individual parameters. Conclusion Systemic inflammation and disordered mineral metabolism are both significantly associated with AVF stenosis in MHD patients, whereas inflammatory burden appears more closely linked to repeated interventions. A multidimensional risk assessment strategy incorporating these markers may improve early identification of high-risk patients and support more targeted vascular access management. Arteriovenous fistula stenosis Neutrophil-to-lymphocyte ratio Systemic immune-inflammation index Parathyroid hormone Calcium–phosphate product Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 18 Apr, 2026 Reviewers agreed at journal 07 Apr, 2026 Reviewers agreed at journal 06 Apr, 2026 Reviewers invited by journal 05 Apr, 2026 Editor assigned by journal 11 Mar, 2026 Submission checks completed at journal 11 Mar, 2026 First submitted to journal 06 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9055359","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":618948700,"identity":"2e639c48-4bcc-48da-bb13-c89c2cf079ea","order_by":0,"name":"kun yang","email":"","orcid":"","institution":"North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"kun","middleName":"","lastName":"yang","suffix":""},{"id":618948701,"identity":"1d987abf-6cf2-415a-8b6a-c8210f2086ff","order_by":1,"name":"Wenxu Pan","email":"","orcid":"","institution":"the Second Naval Hospital of Southern Theater Command of 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Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Arteriovenous fistula stenosis, Neutrophil-to-lymphocyte ratio, Systemic immune-inflammation index, Parathyroid hormone, Calcium–phosphate product","lastPublishedDoi":"10.21203/rs.3.rs-9055359/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9055359/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e \u003cbr\u003e\nArteriovenous fistula (AVF) dysfunction remains a major barrier to adequate dialysis delivery in patients undergoing maintenance hemodialysis (MHD), frequently resulting in repeated interventions and increased healthcare burden. Although chronic inflammation and mineral metabolism abnormalities are both implicated in vascular remodeling, their integrated clinical significance in AVF stenosis has not been well defined. Leveraging large-scale real-world data, this cross-sectional study aimed to comprehensively evaluate the associations of inflammatory indices and calcium–phosphate metabolism parameters with AVF stenosis and repeated percutaneous transluminal angioplasty (PTA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods \u003c/strong\u003e\u003cbr\u003e\nIn this single-center cross-sectional study, 683 MHD patients with AVF stenosis requiring PTA were enrolled as the case group, while 255 contemporaneous patients with normally functioning AVFs served as controls. Demographic characteristics, comorbidities, dialysis vintage, laboratory measurements, mineral metabolism markers, and inflammatory indices were collected. Inflammatory markers—including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to–high-density lipoprotein ratio (NHR), and systemic immune-inflammation index (SII)—were derived from peripheral blood counts. Multivariable logistic regression analyses were conducted to identify variables independently associated with AVF stenosis and repeated PTA within 12 months. Discriminatory performance was evaluated using receiver operating characteristic (ROC) curves, with subgroup analyses performed according to diabetes status and sex.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults \u003c/strong\u003e\u003cbr\u003e\nPatients with AVF stenosis exhibited significantly higher serum phosphorus, intact parathyroid hormone (iPTH), calcium–phosphate product, NLR, PLR, and SII levels, alongside lower LMR and lymphocyte counts (all \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05). Elevated iPTH, NLR, SII, calcium–phosphate product, and diabetes were independently associated with AVF stenosis. Among patients with established stenosis, higher NLR, diabetes, longer dialysis vintage, female sex, and lower serum albumin were independently associated with repeated PTA. Subgroup analyses suggested stronger associations with repeated interventions among diabetic and female patients. Notably, prediction models integrating inflammatory and mineral metabolism markers demonstrated superior discriminatory capacity compared with individual parameters.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSystemic inflammation and disordered mineral metabolism are both significantly associated with AVF stenosis in MHD patients, whereas inflammatory burden appears more closely linked to repeated interventions. A multidimensional risk assessment strategy incorporating these markers may improve early identification of high-risk patients and support more targeted vascular access management.\u003c/p\u003e","manuscriptTitle":"Integrated Impact of Inflammation and Mineral Metabolism on Arteriovenous Fistula Stenosis and Repeated Intervention in Maintenance Hemodialysis: A Real-World Cross- Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-09 12:34:33","doi":"10.21203/rs.3.rs-9055359/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-18T16:09:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167986652084719936817025105881136004398","date":"2026-04-07T12:35:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167532555380800082837734598222321914691","date":"2026-04-06T15:37:27+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-05T10:02:11+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-11T09:43:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-11T09:42:08+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2026-03-07T04:39:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f9f06f14-812c-43a5-be32-2f2f62726705","owner":[],"postedDate":"April 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-09T12:34:33+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-09 12:34:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9055359","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9055359","identity":"rs-9055359","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}