Ciucanu Claudiu Constantin, Mureșan Alexandru, Florea Elena, Réka Bartus, Mureșan Adrian Vasile, Szanto Ludovic-Alexandru, Arbănași Eliza-Mihaela, Hosu Ioan, Russu Eliza, Arbănași Emil-Marian
Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania.
Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania.
J Clin Med. 2025 Jan 14;14(2):488. doi: 10.3390/jcm14020488.
: The autologous arteriovenous fistula (AVF) is the preferred choice for vascular access in patients with end-stage kidney disease (ESKD) undergoing maintenance hemodialysis. However, in the long term, the primary patency of AVF is suboptimal, with an AVF failure of approximately 30% in one year. The aim of this study is to examine how the pre-operative baseline levels of interleukin-6 (IL-6) affect long-term AVF failure. : This retrospective, observational study involves ESKD patients admitted to the Vascular Surgery Clinic for AVF creation from January 2020 to December 2023. Ultimately, a total of 91 patients whose AVFs matured and began dialysis were enrolled. Prior to surgery, each patient underwent a thorough blood sample collection, with IL-6 levels assessed. The patients were categorized into two groups: those with functioning AVFs and those with dysfunctional AVFs. Their progress was monitored via a review of medical records, telephone interviews, or direct contact. Following the surgery, patients were observed for an average of 1.53 ± 0.94 years. : During the follow-up, patients who experienced AVF failure had a higher incidence of diabetes mellitus ( = 0.019) and active smoking ( = 0.012), as well as higher levels of IL-6 ( < 0.001). At ROC analysis, we found a strong association between IL-6 value and AVF failure (AUC: 0.814, < 0.001), with an optimal cut-off value of 7.08 (76.5% Sensitivity and 79.7% Specificity). Furthermore, at the survival curve Kaplan-Meier analysis, we observed a higher occurrence of AVF failure in patients with baseline IL-6 values above the median ( = 0.004), in tertile 3 ( = 0.002), and above the optimal cut-off value ( < 0.001). At cox-regression analysis, elevated baseline IL-6 levels are associated with AVF Failure (HR: 2.23, < 0.001). : In the current study, we demonstrated that elevated IL-6 levels at baseline are associated with long-term AVF failure, independent of age, sex, and cardiovascular risk factors.
自体动静脉内瘘（AVF）是终末期肾病（ESKD）患者维持性血液透析血管通路的首选。然而，从长期来看，AVF的初始通畅率并不理想，一年内AVF失败率约为30%。本研究的目的是探讨术前白细胞介素-6（IL-6）基线水平如何影响AVF的长期失败情况。
这项回顾性观察研究纳入了2020年1月至2023年12月因创建AVF而入住血管外科诊所的ESKD患者。最终，共有91例AVF成熟并开始透析的患者被纳入研究。手术前，每位患者都进行了全面的血液样本采集，并评估了IL-6水平。患者被分为两组：AVF功能正常组和功能异常组。通过查阅病历、电话访谈或直接联系对他们的病情进展进行监测。手术后，对患者平均观察了1.53±0.94年。
在随访期间，发生AVF失败的患者糖尿病发病率更高（P = 0.019）、主动吸烟率更高（P = 0.012），IL-6水平也更高（P < 0.001）。在ROC分析中，我们发现IL-6值与AVF失败之间存在密切关联（AUC：0.814，P < 0.001），最佳截断值为7.08（灵敏度76.5%，特异性79.7%）。此外，在生存曲线的Kaplan-Meier分析中，我们观察到基线IL-6值高于中位数的患者（P = 0.004）、处于三分位数3的患者（P = 0.002）以及高于最佳截断值的患者中AVF失败发生率更高（P < 0.001）。在Cox回归分析中，基线IL-6水平升高与AVF失败相关（HR：2.23，P < 0.001）。
在本研究中，我们证明基线IL-6水平升高与AVF长期失败相关，且不受年龄、性别和心血管危险因素的影响。
