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

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.

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.

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).

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.