The Positive Association of Homocysteine (Hcy) with Arteriovenous Fistula Thrombosis (AVFT) in Chinese Patients on Hemodialysis: A Retrospective Cohort Study

Background

Homocysteine (Hcy) is generally elevated in dialysis patients and is one of the independent risk factors for thrombosis. However, the relationship between Hcy level and the risk of arteriovenous fistula thrombosis (AVFT) has not yet fully been understood. Current evidence regarding this association is limited, particularly among Chinese populations. Given the significance of this relationship in health care and public health, further investigation is essential. This study aims to clarify the association between Hcy and AVFT. In addition, it seeks to examine the synergistic effects of Hcy alongside other factors influencing AVFT. It also intends to determine how Hcy interacts with variables such as diabetes and impacts the risk of AVFT.

Methods

A retrospective cohort study was conducted involving 983 hemodialysis patients. Data on demographic characteristics, comorbidities, laboratory test indicators, and clinical symptoms were collected from all participants. Statistical analyses, including logistic regression, smooth curve fitting, and joint interaction effects analysis, were employed to address the research questions.

Results

The overall prevalence of AVFT in the study population was 16.20%. A significant association between Hcy levels and the risk of AVFT was found (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.11–1.16; P < 0.001). This association remained significant after adjusting for multiple variables (OR, 1.13; 95% CI, 1.11–1.17; P < 0.001). Participants were categorized into high and low Hcy groups based on the median (25.2 μmol/L), with a significantly elevated risk of AVFT was observed in the high Hcy group compared to the low Hcy group (OR, 5.55; 95% CI, 3.59–8.55; P < 0.001). This risk remained significantly elevated after adjustment for covariates (OR, 3.59; 95% CI, 1.83–7.55, P < 0.001). Subsequent exploratory subgroup analyses revealed similar significant interactions (all P values for interaction >0.05). Furthermore, sensitivity analyses indicated that diabetes and Hcy levels exhibit a synergistic multiplicative and additive interaction in the risk of AVFT (both P < 0.05).

Conclusion

The findings suggest that elevated Hcy levels are linked to an increased risk of AVFT. The data highlight diabetes as a synergistic interaction factor through which Hcy influences AVFT risk. These results underscore the necessity for further research, especially considering potential confounding factors. Future studies should aim to confirm these findings and explore the underlying mechanisms of the observed associations.