The Predictive Value of Platelet-to-Monocyte Ratio for Distal Arteriovenous Fistula Failure: A Retrospective Cohort Study.

Abstract

Purpose: Arteriovenous (AV) fistula maturation remains a significant challenge in hemodialysis patients, frequently compromised by chronic inflammation and thrombotic events. This study aimed to investigate the predictive value of the Platelet-to-Monocyte Ratio and other systemic inflammatory markers in determining AV fistula maturation success.

Materials and methods: This retrospective study included 186 patients who underwent autologous AV fistula creation between December 2022 and August 2025. Preoperative laboratory data, including complete blood count and C-reactive protein, were collected. Patients were divided into "Success" (n = 146) and "Failure" (n = 40) groups based on functional maturation within 4 weeks. Inflammatory indices (neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-monocyte ratio, and C-reactive protein-to-albumin ratio) were calculated. Statistical analysis was performed using Python.

Results: The maturation failure rate was 21.5%. Absolute monocyte counts were significantly lower in the failure group [0.55 vs. 0.69 (103/μL); p = 0.028]. The platelet-to-monocyte ratio was significantly higher in patients with maturation failure [343 vs. 284; p = 0.042]. In Receiver Operating Characteristic analysis, the platelet-to-monocyte ratio demonstrated the highest discriminative power among all indices (AUC: 0.61, cut-off: 236). However, the platelet-to-monocyte ratio was not identified as an independent risk factor in multivariate logistic regression (p = 0.244).

Conclusion: A high preoperative platelet-to-monocyte ratio and low absolute monocyte count are associated with AV fistula maturation failure. While the platelet-to-monocyte ratio is not a strong independent predictor, it serves as an auxiliary biomarker reflecting the balance between thrombotic activity and vascular remodeling.