Blood osteoprotegerin is associated with arteriovenous access thrombosis in hemodialysis patients

A functioning arteriovenous (AV) access is essential for hemodialysis efficiency and the quality of life in hemodialysis patients. Blood osteoprotegerin (OPG) and soluble receptor activator of nuclear factor kappa B ligand (RANKL) have been linked to cardiovascular diseases and vascular calcification. This study investigated the relationship between blood OPG, RANKL, and the occurrence of AV access thrombosis.

This prospective cohort study was conducted from August 2016 to August 2021 and included patients undergoing prevalent hemodialysis in two hospital-based hemodialysis units. Cox proportional hazards models and Kaplan-Meier analysis were used to evaluate the association between blood OPG, RANKL, and AV access (AV fistula [AVF] and AV graft [AVG]) outcomes.

A total of 333 hemodialysis patients were enrolled, with an AV access thrombosis rate of 22.2%. Cox regression identified several factors associated with AV access thrombosis: AV access type (AVF vs. AVG; hazard ratio [HR], 0.24; p < 0.001), C-reactive protein (HR, 1.07; p = 0.002), and log-transformed OPG (HR, 5.52; p = 0.005). Subgroup analysis revealed high log-transformed OPG and RANKL were associated with AVF thrombosis (HR, 10.77; p = 0.002 and HR, 3.26; p = 0.009, respectively), while high C-reactive protein increased the risk of AVG thrombosis (HR, 1.31; p < 0.001). Kaplan-Meier analysis showed that patients with AVF in the highest tertile of log OPG (>402 pg/mL) had the highest AVF thrombosis incidence (p = 0.03).

High blood OPG was associated with AV access thrombosis, particularly in the AVF.