Association between Preoperative Monocyte-to-Lymphocyte Ratio and Late Arteriovenous Fistula Dysfunction in Hemodialysis Patients: A Cohort Study

Abstract

<b><i>Background:</i></b> Inflammation appears to be at the biological core of arteriovenous fistula (AVF) dysfunction, and the occurrence of AVF dysfunction is related to high death and disability in hemodialysis (HD) patients. Despite several studies on the correlations between AVF dysfunction and inflammatory indicators, how AVF dysfunction is related to the monocyte-to-lymphocyte ratio (MLR) is much unclear. We hypothesize that preoperative MLR is associated with AVF dysfunction in Chinese HD patients. <b><i>Methods:</i></b> In this single-center retrospective cohort study, totally 769 adult HD patients with a new AVF created between 2011 and 2019 were included. Association of preoperative MLR with AVF dysfunction (thrombosis or decrease of normal vessel diameter by >50%, requiring either surgical revision or percutaneous transluminal angioplasty) was assessed by multivariable Cox proportional hazard regression. <b><i>Results:</i></b> The patients were aged 55.8 ± 12.2 years and were mostly males (55%). During the average 32-month follow-up (maximum 119 months), 223 (29.0%) patients had permanent vascular access dysfunction. In adjusted multivariable Cox proportional hazard regression analyses, the risk of AVF dysfunction was 4.32 times higher with 1 unit increase in MLR (hazard ratio [HR]: 5.32; 95% confidence interval [CI]: 3.1–9.11). Compared with patients with MLR <0.28, HRs associated with an MLR of 0.28–0.41 and ≥0.41 are 1.54 (95% CI: 1.02–2.32) and 3.17 (2.18–4.62), respectively. <b><i>Conclusions:</i></b> A higher preoperative MLR is independently connected with a severer risk of AVF dysfunction in HD patients. Its clinical value should be determined in the future.

Monocyte‐to‐lymphocyte ratio and gastrointestinal disorder‐related hospitalization in patients on maintenance hemodialysis

“…Thus, combining monocytes and lymphocytes seems to be a good strategy to evaluate inflammation and it may react with high sensitivity on even minor changes in uremic settings. Therefore, in dialysis patients, MLR was not only related to the hospitalization risk of GI disorder in this study but also related to cardiovascular events, infectious diseases, late arteriovenous fistula dysfunction, mortality of CVD, and all-cause mortality in other studies [11,15,[41][42][43].…”

The risk factors for arteriovenous fistula dysfunction in maintenance hemodialysis patients: A cross‐sectional study

“…Studies have demonstrated that higher monocyte/lymphocyte ratios are associated with AVF dysfunction. Similarly, Hu et al 20 found a significant association between elevated monocyte/lymphocyte ratios and AVF stenosis, a condition leading to AVF dysfunction.…”

“…AVF dysfunction in hemodialysis can result from thrombosis or clotting within the fistula, disrupting blood flow and impeding treatment. Elevated prothrombin activity and lower prothrombin time in the AVF 20 found a significant association between elevated monocyte/lymphocyte ratios and AVF stenosis, a condition leading to AVF dysfunction.…”

Regulation of vascular remodeling by immune microenvironment after the establishment of autologous arteriovenous fistula in ESRD patients

“…The monocyte-to-lymphocyte ratio (MLR) is defined as the absolute number of monocytes divided by the absolute number of lymphocytes. Several studies have found a positive correlation between MLR and AVF immaturity ( 43 ). The release of macrophage migration inhibitor factor (MIF) up-regulates tumor necrosis factor (TNF) -α, interleukin (IL) -6, IL-8 and MCP-1 and other inflammatory cytokines, causing the migration and proliferation of inflammatory cells and promoting NIH ( 19 ).…”