Abstract: 【Abstract】Objective To explore the chronic risk factors for the dysfunction of mature autogenous arteriovenous fistulas (AVFs) in maintenance hemodialysis (MHD) patients through the analyses of their general condition, dialysis index, inflammation and nutritional status. Methods This was a retrospective case-control analysis. A total of 248 MHD patients were recruited from the 404 MHD patients treated in two hemodialysis centers, and divided into dysfunction group (n=53) and patent group (n=195). Clinical data were collected and compared between the two groups in order to find out the risk factors for dysfunction of mature AVFs. Multivariate logistic regression was also used to investigate the independent risk factors for dysfunction of mature AVFs. Results ①There were no significant differences in gender (c2=0.007, P=0.932), AVF age (c2=5.803, P=0.055), initial blood flow in AVF (t=- 1.662, P=0.098), dialysis age (t=0.284, P=0.509), white blood cell count (t '=0.977, P=0.331), serum albumin (t=0.656, P=0.512) and prothrombin time (t=-1.639, P=0.102) between the two groups. ②There were significant differences in primary disease (c2=8.809, P=0.032), high flux dialysis duration (t=- 5.453, P＜0.001), total dialysis duration (t' =- 3.158, P=0.002), C- reactive protein (t=2.325, P=0.021), serum calcium (t=-3.404, P=0.001), serum phosphorus (t'=4.135, P=0.000), calcium-phosphorus product (t'=2.585, P=0.012), serum parathyroid hormone (t'=3.528, P=0.001), serum cholesterol (t=5.951, P＜0.001) and serum triglycerides (t=2.054, P=0.041) between the two groups. ③The risk for dysfunction of mature AVFs was higher in MHD patients with diabetic nephropathy (OR=8.652, 95% CI: 2.111～35.460, P=0.003), hypertension nephropathy (OR=7.300, 95% CI: 1.537～34.672, P=0.012), higher serumphosphorus (OR=6.323, 95% CI: 1.881～21.253, P=0.003), higher parathyroid hormone (OR=1.002, 95% CI:1.001～1.004, P=0.007) and higher serum cholesterol (OR=5.570, 95% CI: 2.598～11.943, P＜0.001), and was lower in those with moderate hypocalcemia (OR=0.066, 95% CI: 0.007～0.611, P=0.017) and longer high flux dialysis period (OR=0.765, 95% CI: 0.666～0.878, P＜0.001). Conclusion ①The related risk factors for the dysfunction of mature AVFs included primary disease, high flux dialysis duration, total dialysis duration, C-reactive protein, serum calcium, serum phosphorus, calcium-phosphorus product, serum parathyroid hormone, serum cholesterol and serum triglycerides. ②The independent risk factors for the dysfunction of mature AVFs included diabetic nephropathy, hypertension nephropathy and calcium, phosphorus and lipid metabolism disturbances. ③ Clinically, increase of high flux dialysis period is useful for the prevention of mature AVF from dysfunctioning.

Key words: Mature autogenous arteriovenous fistula, Independent risk factors, High flux dialysis time