Systemic Profile of Cytokines in Arteriovenous Fistula Patients and Their Associations with Maturation Failure

Background: Systemic cytokines are elevated in chronic kidney disease (CKD) and hemodialysis patients compared to the general population. However, whether cytokine levels interfere with vascular remodeling increasing the risk of arteriovenous fistula (AVF) failure remains unknown. Methods: This is a case-control study of 64 patients who underwent surgery for AVF creation (32 with AVF maturation failure and 32 matching controls with successful maturation). A total of 74 cytokines, including chemokines, interferons, interleukins, and growth factors, were measured in preoperative plasma samples using multiplex assays. Sixty-two patients were included in the statistical analyses. Associations with AVF failure were assessed using paired comparisons and conditional logistic regressions accounting for paired strata. Results: Seven cytokines were significantly higher in patients with AVF maturation failure than in matching controls (G-CSF, IL-6, MDC, RANTES, SDF-1α/β, TGFα, and TPO). Of these, G-CSF (odds ratio 1.71 [1.05-2.79] per 10 pg/mL), MDC (1.60 [1.08-2.38] per 100 pg/mL), RANTES (1.55 [1.10-2.17] per 100 pg/mL), SDF-1α/β (1.18 [1.04-1.33] per 1000 pg/mL), and TGFα (OR 1.39 [1.003-1.92] per 1 pg/mL) showed an incremental association by logistic regression. Conclusions: This study identified a profile of plasma cytokines associated with adverse maturation outcomes in AVFs. These findings may open the doors for future therapeutics and markers for risk stratification.