Associations Between a Combined Baseline Inflammation-Malnutrition Risk Score and Future Late Arteriovenous Fistula...

Late arteriovenous fistula (AV fistula) occlusion is a major cause of morbidity in hemodialysis patients. The Systemic Immune-Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), and Geriatric Nutritional Risk Index (GNRI) have emerged as candidate prognostic biomarkers. This study aimed to compare their predictive accuracy, evaluate their independent prognostic value, and develop a combined risk score.

This retrospective cohort study included 750 hemodialysis patients undergoing primary AV fistula creation. Baseline Systemic Immune-Inflammation Index, Neutrophil-to-Lymphocyte Ratio, and Geriatric Nutritional Risk Index were collected preoperatively. The primary outcome was late AV fistula occlusion (> 90 days). Predictive performance was assessed using ROC analysis and Cox proportional hazards regression.

Over a median follow-up of 48 months, 38.0% of patients developed late AV fistula occlusion. Systemic Immune-Inflammation Index demonstrated the highest predictive accuracy (AUC: 0.79), significantly outperforming Geriatric Nutritional Risk Index (p < 0.001). In multivariate analysis, Systemic Immune-Inflammation Index > 850 (Hazard ratios 3.15, 95% CI: 2.28-4.35), Neutrophil-to-Lymphocyte Ratio > 4.5 (Hazard ratios 2.78, 95% CI: 2.02-3.82), and Geriatric Nutritional Risk Index < 92 (Hazard ratios 1.92, 95% CI: 1.41-2.62) were independent predictors. A combined risk score integrating these biomarkers achieved superior discrimination (AUC: 0.83). Baseline vascular diameters were not independently associated with occlusion risk in this cohort.

The synergistic interaction between inflammation and malnutrition identifies a distinct high-risk phenotype. The combined risk score is a readily implementable tool that may support personalized surveillance strategies to improve long-term AV fistula outcomes in hemodialysis patients.