The predictive value of inflammatory biomarkers for arteriovenous fistula failure: A systematic review and meta-analysis

Background: Hemodialysis requires reliable vascular access, and arteriovenous fistulas (AVF) are preferred for their superior patency and fewer complications. However, AVF failure remains high, with 50% becoming nonfunctional within 2 years. Inflammatory biomarkers can contribute to AVF failure, yet the specific biomarkers involved remain to be identified. Aim: We aim to determine the prognostic significance of inflammatory biomarkers in predicting primary AVF failure in hemodialysis patients. Methods: The electronic search was performed in different databases: PubMed, Embase, and Cochrane Library, from inception to June 2024. Statistical analysis was performed using R software 4.3.1. A random-effects model was employed to compute mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) for continuous and binary endpoints. The results were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement guideline. Results: A total of 15 studies, encompassing 1809 patients with a mean age of 62 years, were included. Over follow-up ranging from 6 weeks to 26 months, we did not observe a significant difference in the levels of monocyte chemotactic protein 1 (MCP-1; 12.15 pg/mL; 95% CI −14.26 to 38.56; p = 0.37), tumor necrosis factor alpha (TNF-α; 0.90 pg/mL; 95% CI −38.77 to 40.57; p = 0.96) and white blood cells (WBC; 0.31 g/L; 95% CI −0.05 to 0.66; p = 0.09) between the group experiencing AVF maturation and those facing AVF failure. However, there was a significant elevation in C-reactive protein (CRP) levels in the AVF failure group (2.89 mg/L; 95% CI 0.31–5.47; p = 0.03). Conclusions: Despite the increased CRP values within the AVF failure cohort and the significance noted in individual studies, our investigation did not find discernible effects attributable to other inflammatory and fibrotic biomarkers.