Recurrent Intradialytic Hypotension Increases AV Fistula Failure Risk Ten-fold

Toulan, Safwa; Alghannam, Mohamed; Gomaa, Azza

doi:10.21608/ejhm.2025.420371.1836

Recurrent Intradialytic Hypotension Increases AV Fistula Failure Risk Ten-fold

Document Type : Original Article

Authors

¹ Internal Medicine Department, Nephrology Unit, Faculty of Medicine, Menoufia University, Menoufia, Egypt

² Radiodiagnosis, Interventional Radiology and Medical Imaging Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt

10.21608/ejhm.2025.420371.1836

Abstract

Background: Arteriovenous fistulas (AVFs) remain the preferred vascular access for hemodialysis (HD) owing to their superior patency and lower complication rates compared to other modalities. yet AVF failure remains a major cause of morbidity and increased healthcare costs.
Aim: This study aimed to identify clinical, cardiovascular, and laboratory risk factors associated with AVF failure in HD patients.
Patients and Methods: A cohort of 64 HD patients were retrospectively assessed for AVF failure risk factors. Patients were classified into two groups: AVF failure (n=26) and functioning AVFs (n=38). then AVF failure group was further subdivided into 2 subgroups (failure with a chance for the patient to have another AVF and failure without a chance to the patient to have another AVF). Data were collected and predictors of AVF failure were evaluated using univariate and multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis.
Results: Intradialytic hypotension (IDH) was identified as the strongest independent predictor of AVF failure (OR = 9.7, p=0.001; AUC = 0.709, p=0.002) increasing the risk ten-fold. Additional significant risk factors included dialysis duration > 2 years and elevated hemoglobin and hematocrit levels. ROC analysis confirmed dialysis duration and IDH as strong predictors, with sensitivities of 88.5% and 65.4% respectively. Elevated white blood cell count and pre-dialysis blood urea nitrogen were also significant correlates.
Conclusion: IDH and dialysis duration were the most potent predictors of AVF failure, highlighting the necessity of close intradialytic BP monitoring to enhance vascular access survival. These findings warrant validation through larger multicenter studies to inform preventive strategies.

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