Abstract: Objective To investigate the predictive value of serum matrix metalloproteinase-2 (MMP-2) and vascular cell adhesion molecule-1 (VCAM-1) for autogenous arteriovenous fistula (AVF) failure in maintenance hemodialysis (MHD) patients.  Methods   A total of 197 uremic patients undergoing MHD in this hospital from March 2021 to June 2024 were selected as the research subjects. According to the diagnostic criteria for AVF failure, the patients were assigned into an AVF normal group (116 cases) and an AVF failure group (81 cases). Enzyme linked immunosorbent assay (ELISA) kits were used to detect serum MMP-2 and VCAM-1. Laboratory indicators including blood calcium and phosphorus, hemoglobin, and platelet were routinely detected. Spearman correlation analysis was used for correlation analysis. Multivariate logistic regression model was applied to analyze the influencing factors for AVF failure in MHD patients. Receiver operating characteristic (ROC) was applied to analyze the predictive value of serum MMP-2 and VCAM-1 for AVF failure in MHD patients.  Results  In AVF failure group, intradialytic hypotension (χ2=9.167, P=0.002), AVF stenosis (χ2=19.391, P＜0.001), hyper-coagulation predisposition (χ2=43.585, P＜0.001), low platelet (χ2=20.494, P＜0.001), compression time ≥30 min on puncture site (χ2=26.204, P＜0.001), serum MMP-2 (t=7.640, P＜0.001) and serum VCAM-1 (t=7.801, P＜0.001) were higher than those in AVF normal group. AVF stenosis, hyper-coagulation predisposition, and compression time on puncture site were positively correlated with serum MMP-2 (r/rs=0.510, 0.443 and 0.431 respectively; P＜0.001) and serum VCAM-1 (r/rs=0.519, 0.436 and 0.455 respectively; P＜0.001), while blood pressure and platelet were negatively correlated with serum MMP-2 (r=-0.462 and -0.605; P＜0.001) and serum VCAM-1 (r=-0.465 and -0.623; P＜0.001) levels. Intradialytic hypotension (OR=2.964, 95% CI: 1.516～5.794, P=0.001), low platelet (OR=2.974, 95% CI: 1.463～6.046, P=0.003), hyper-coagulation predisposition (OR=2.879, 95% CI: 1.405～5.899, P=0.004), compression time ≥30 minutes on puncture site (OR=3.246, 95% CI: 1.737～6.066, P＜0.001), serum MMP-2 (OR=3.447, 95% CI: 1.830～6.492, P＜0.001) and serum VCAM-1 (OR=3.426, 95% CI: 1.971～5.954, P＜0.001) were the risk factors for AVF failure in MHD patients. The area under the curves (AUC) of serum MMP-2 and serum VCAM-1 for predicting AVF failure were 0.789 and 0.785 respectively; the AUC of combined serum MMP-2 and VCAM-1 for the prediction was 0.889, which was superior to the prediction ability using serum MMP-2 (Z=3.323, P=0.001) or serum VCAM-1 (Z=3.486, P=0.001) alone.  Conclusion  MMP-2 and VCAM-1 are positively correlated with AVF stenosis, hyper-coagulation predisposition, and longer compression time on puncture site, and negatively correlated with blood pressure and platelet level. Serum MMP-2 and VCAM-1 can predict AVF failure in MHD patients, and combination of the two serum levels obtains better prediction ability.

Key words: Maintenance hemodialysis, Autogenous arteriovenous fistula failure, Matrix metalloproteinase-2, Vascular cell adhesion molecule-1