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

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.