Association of serum uric acid/albumin ratio, C-reactive protein, and hemodynamic mismatch with arteriovenous fistula complications: A retrospective cohort study

Aim: Arteriovenous fistula (AVF) complications remain a major challenge in hemodialysis patients. This study aimed to evaluate the relationship between the serum uric acid/albumin ratio (UAR), C-reactive protein (CRP), and the development of AVF complications.

Material and Methods: This retrospective cohort study included 358 hemodialysis patients with functioning AVFs, divided into complication (n=120) and no-complication (n=238) groups. UAR, CRP, and Doppler ultrasound findings were compared between groups. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of UAR and CRP. 

Results: AVF complications occurred in 33.5% of patients. Median UAR was significantly higher in patients with complications compared to those without (1.99 [IQR: 1.65–2.35] vs. 1.76 [IQR: 1.47–2.06], p<0.001). Mean CRP levels were also elevated in the complication group (6.5±2.1 mg/L vs. 3.2±1.8 mg/L, p<0.001). ROC analysis demonstrated that UAR had an AUC of 0.76, whereas CRP had an AUC of 0.70. Hemodynamic mismatch was significantly associated with higher complication rates (p=0.007).

Conclusion: Both UAR and CRP levels were independently associated with AVF complications, but UAR demonstrated superior predictive performance. UAR may therefore serve as a practical biomarker for the early identification of patients at risk of vascular access dysfunction, although further prospective studies are needed to validate these findings.