Elevated advanced glycation endproducts is a risk factor for stenosis after primary arteriovenous fistula surgery

doi:10.12122/j.issn.1673-4254.2025.08.11

Abstract

Abstract:

Objective To investigate the effect of serum advanced glycation endproducts (AGEs) on stenosis after first autologous arteriovenous fistula (AVF) in patients with end-stage renal disease (ESRD). Methods Patients with ESRD undergoing standard native arteriovenous fistula (AVF) for the first time in the Department of Nephrology, Affiliated Hospital of Guilin Medical University from February to June 2022 were prospectively enrolled. The preoperative general data, clinical examination results and ultrasound data of the operated limbs were collected. The patients with and without stenosis within 2 months after the operation were compared for preoperative serum AGEs levels detected using ELISA and the clinical parameters. Logistic regression analysis was used to analyze the independent risk factors of AVF stenosis, and the sensitivity and specificity of AGEs for predicting postoperative stenosis were analyzed using receiver-operating characteristic (ROC) curve. Results Of the 94 patients enrolled, 34 had postoperative arteriovenous stenosis and 60 had no stenosis. The number of diabetic patients differed significantly between stenosis group and non-stenosis group (P<0.001). Serum AGEs levels, which were negatively correlated with serum phosphorus level (P<0.05), were significantly higher in stenosis group than in non-stenosis group (Z=-2.837, P=0.005). Serum AGE level was an independent risk factor for postoperative stenosis after AVF (OR=1.251, 95% CI:1.096-1.423, P<0.001). For predicting AVF stenosis, the area under the ROC curve (AUC) of AGEs was 0.677 (P=0.007, 95% CI: 0.572-0.770), with a specificity of 90.00% and a sensitivity of 52.94% at the optimal cut-off value of 8.43 µg/mL; AGEs combined with fibrinogen had an AUC of 0.763 (P<0.001, 95% CI: 0.664-0.844), with a specificity of 73.33% and a sensitivity of 70.59% at the optimal cut-off value of 0.30. Conclusions Elevated serum AGEs level is an independent risk factor for postoperative AVF stenosis, and its combination with fibrinogen has a better efficacy for predicting postoperative AVF stenosis.

Key words: advanced glycation end products, arteriovenous fistula stenosis, end-stage renal disease, fibrinogen

Tianhong LI, Xinfang QIN, Lili WEI, Huixin BI. Elevated advanced glycation endproducts is a risk factor for stenosis after primary arteriovenous fistula surgery[J]. Journal of Southern Medical University, 2025, 45(8): 1663-1671.

Figures/Tables 8

References 46

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Variables	Stenosis group (n=34)	Non-stenosis group (n=60)	x² /Z/t	P
Age (year, Mean±SD)	58±13	54±13	1.340	0.183
Gender (male/female) [n (%)]	19/15 (55.88)	36/24 (60.00)	0.152	0.697
Hyperlipemia [n (%)]	10 (29.41)	10 (16.67)	2.105	0.147
Hypertension [n (%)]	28 (82.35)	55 (91.67)	1.822	0.177
Smoking history [n (%)]	5 (14.71)	12 (20.00)	0.411	0.522
Diabetes [n (%)]	18 (52.94)	5 (8.33)	23.367	<0.001

Variables	Stenosis group (n=34)	Non-stenosis group (n=60)	x² /Z/t	P
Age (year, Mean±SD)	58±13	54±13	1.340	0.183
Gender (male/female) [n (%)]	19/15 (55.88)	36/24 (60.00)	0.152	0.697
Hyperlipemia [n (%)]	10 (29.41)	10 (16.67)	2.105	0.147
Hypertension [n (%)]	28 (82.35)	55 (91.67)	1.822	0.177
Smoking history [n (%)]	5 (14.71)	12 (20.00)	0.411	0.522
Diabetes [n (%)]	18 (52.94)	5 (8.33)	23.367	<0.001

Variables	Stenosis group (n=34)	Non-stenosis group (n=60)	t/Z	P
RBC (10¹²/L)	2.87 (2.55, 3.13)	2.85±0.67	-0.024	0.981
WBC (10⁹/L)	8.06 (5.89, 9.50)	7.15 (5.75, 9.07)	-1.137	0.256
Hb (g/L)	80.83±17.54	80.29±17.37	-0.144	0.886
PLT (10⁹/L)	259.24±93.72	190.50 (166.25, 239.75)	-2.526	<0.05
NEUT (10⁹/L)	5.19 (4.14, 7.36)	5.01 (3.91, 6.55)	-0.952	0.341
LY (10⁹/L)	1.27 (0.94, 1.72)	1.21 (0.81, 1.51)	-1.003	0.316
NLR	4.15 (2.91, 5.50)	3.81 (2.69, 6.31)	-0.362	0.717
PLR	212.40±91.31	172.60 (117.48, 231.73)	-1.180	0.238
Alb (g/L)	37.40 (33.78, 40.50)	37.65 (34.40, 39.68)	-0.354	0.723
TC (mmol/L))	4.31±1.07	3.94±1.05	1.642	0.104
TG (mmol/L)	1.11 (0.85, 1.87)	1.16 (0.80, 1.50)	-0.390	0.697
HDL-C (mmol/L)	0.94 (0.73, 1.23)	1.08±0.33	-1.047	0.295
LDL-C (mmol/L)	2.52±0.74	1.08±0.33	13.020	<0.01
ApoA (mmol/L)	1.08 (1.02, 1.24)	1.18±0.21	-1.316	0.188
ApoB (mmol/L)	0.80 (0.68, 0.96)	0.73±0.18	-1.909	0.053
Lp(a) (mmol/L)	30.00 (18.03, 79.08)	31.50 (16.43, 57.50)	-0.657	0.511
Scr (μmol/L)	818.65±304.00	872.08±271.07	-0.879	0.382
eGFR (mL/min/ 1.73m²)	6.03 (5.37, 8.58)	6.26 (5.03, 7.82)	-0.130	0.897
UA (μmol/L)	528.34±158.53	512.43±128.45	0.529	0.598
iPTH (pmol/L)	21.04 (16.23, 28.44)	24.33 (17.03, 31.20)	-1.007	0.314
Ca (mmol/L)	1.83±0.20	1.98±0.29	-1.927	0.057
P (mmol/L)	2.01 (1.64, 2.57)	2.07±0.53	-0.016	0.987
HCT (%)	0.25±0.54	0.25±0.55	-0.377	0.707
PT (s)	11.85 (11.20, 13.10)	12.00 (11.15, 12.50)	-0.555	0.579
APTT (s)	29.95 (27.50, 33.70)	28.50 (25.30, 31.30)	-2.038	<0.05
FIB (g/L)	4.30±1.29	3.56 (3.19, 4.41)	-1.897	0.058
D-dimer (μg/mL)	1.95 (0.57, 3.04)	0.87 (0.43, 2.80)	-1.436	0.151
BUN (mmol/L)	30.02±14.38	29.17±8.55	0.362	0.719

Variables	Stenosis group (n=34)	Non-stenosis group (n=60)	t/Z	P
RBC (10¹²/L)	2.87 (2.55, 3.13)	2.85±0.67	-0.024	0.981
WBC (10⁹/L)	8.06 (5.89, 9.50)	7.15 (5.75, 9.07)	-1.137	0.256
Hb (g/L)	80.83±17.54	80.29±17.37	-0.144	0.886
PLT (10⁹/L)	259.24±93.72	190.50 (166.25, 239.75)	-2.526	<0.05
NEUT (10⁹/L)	5.19 (4.14, 7.36)	5.01 (3.91, 6.55)	-0.952	0.341
LY (10⁹/L)	1.27 (0.94, 1.72)	1.21 (0.81, 1.51)	-1.003	0.316
NLR	4.15 (2.91, 5.50)	3.81 (2.69, 6.31)	-0.362	0.717
PLR	212.40±91.31	172.60 (117.48, 231.73)	-1.180	0.238
Alb (g/L)	37.40 (33.78, 40.50)	37.65 (34.40, 39.68)	-0.354	0.723
TC (mmol/L))	4.31±1.07	3.94±1.05	1.642	0.104
TG (mmol/L)	1.11 (0.85, 1.87)	1.16 (0.80, 1.50)	-0.390	0.697
HDL-C (mmol/L)	0.94 (0.73, 1.23)	1.08±0.33	-1.047	0.295
LDL-C (mmol/L)	2.52±0.74	1.08±0.33	13.020	<0.01
ApoA (mmol/L)	1.08 (1.02, 1.24)	1.18±0.21	-1.316	0.188
ApoB (mmol/L)	0.80 (0.68, 0.96)	0.73±0.18	-1.909	0.053
Lp(a) (mmol/L)	30.00 (18.03, 79.08)	31.50 (16.43, 57.50)	-0.657	0.511
Scr (μmol/L)	818.65±304.00	872.08±271.07	-0.879	0.382
eGFR (mL/min/ 1.73m²)	6.03 (5.37, 8.58)	6.26 (5.03, 7.82)	-0.130	0.897
UA (μmol/L)	528.34±158.53	512.43±128.45	0.529	0.598
iPTH (pmol/L)	21.04 (16.23, 28.44)	24.33 (17.03, 31.20)	-1.007	0.314
Ca (mmol/L)	1.83±0.20	1.98±0.29	-1.927	0.057
P (mmol/L)	2.01 (1.64, 2.57)	2.07±0.53	-0.016	0.987
HCT (%)	0.25±0.54	0.25±0.55	-0.377	0.707
PT (s)	11.85 (11.20, 13.10)	12.00 (11.15, 12.50)	-0.555	0.579
APTT (s)	29.95 (27.50, 33.70)	28.50 (25.30, 31.30)	-2.038	<0.05
FIB (g/L)	4.30±1.29	3.56 (3.19, 4.41)	-1.897	0.058
D-dimer (μg/mL)	1.95 (0.57, 3.04)	0.87 (0.43, 2.80)	-1.436	0.151
BUN (mmol/L)	30.02±14.38	29.17±8.55	0.362	0.719

Variables	r	P
Age	0.148	0.155
RBC	0.005	0.962
WBC	-0.097	0.352
Hb	0.104	0.319
PLT	0.020	0.851
NEUT	-0.100	0.335
LY	0.080	0.445
NLR	-0.077	0.459
PLR	-0.069	0.509
Alb	-0.040	0.699
TC	0.086	0.409
TG	0.038	0.719
HDL-C	0.096	0.355
LDL-C	0.068	0.512
ApoA	-0.034	0.747
ApoB	0.084	0.421
Lp(a)	-0.031	0.770
Scr	-0.161	0.120
eGFR	0.031	0.768
BUN	-0.141	0.175
UA	-0.071	0.495
iPTH	-0.080	0.443
Ca	0.010	0.920
P	-0.203	＜0.05
HCT	0.057	0.587
PT	-0.151	0.146
APTT	-0.073	0.482
FIB	-0.054	0.608
D-dimer	0.192	0.063
Arterial diameter	-0.178	0.086
Venous diameter	0.115	0.269