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Background <p>Arteriovenous fistula (AVF) thrombosis is a major cause of vascular access failure in patients undergoing maintenance hemodialysis (HD). Although magnesium has established vascular protective properties, its relationship with AVF thrombosis remains poorly characterized. This study aimed to examine the association between serum magnesium levels and the risk of AVF thrombosis in a retrospective cohort of HD patients.</p> Methods <p>This bi-center retrospective cohort study included 408 HD patients treated between January 2020 and May 2025. Baseline serum magnesium was categorized into three thresholds based on the 25th and 75th percentiles of the cohort distribution: T1 ( &lt; 0.87 mmol/L), T2 (0.87–0.97 mmol/L), and T3 (≥0.98 mmol/L). The primary outcome was the first clinically confirmed episode of AVF thrombosis. Kaplan–Meier analysis and multivariable Cox proportional hazard model adjusted for demographic, clinical, and dialysis-related factors were used to assess associations. Sensitivity and subgroup analyses were performed to evaluate the robustness of findings.</p> Results <p>Over a median follow-up of 33.5 months, 83 patients (20.3%) experienced AVF thrombosis. Compared to T1, patients in T2 and T3 groups had significantly lower thrombotic risk: HR 0.57 (95% CI: 0.40–0.82, <i>p</i> = 0.002) and HR 0.46 (0.28–0.77, <i>p</i> = 0.003), corresponding to a 1.75- and 2.17-fold higher risk for T1 versus T2 and T3, respectively. Independent predictors of increased AVF thrombosis risk included older age (HR 1.05 per year, 95% CI: 1.02–1.09), longer AVF duration (HR 1.02 per month, 95% CI: 1.007–1.08), higher serum phosphate (HR 1.11 per 0.1 mmol/L, 95% CI: 1.03–1.48), and use of calcium-based phosphate binders (HR 1.02, 95% CI: 1.003–1.27). Protective factors included male sex (HR 0.87, 95% CI: 0.54–0.98), higher dialysis adequacy (spKt/V; HR 0.16, 95% CI: 0.11–0.35) and statin therapy (HR 0.35, 95% CI: 0.14–0.86). The association between low magnesium and AVF thrombosis remained consistent in sensitivity and subgroup analyses.</p> Conclusions <p>Low serum magnesium (&lt; 0.87 mmol/L) was independently associated with a twofold increased risk of AVF thrombosis in HD patients. Magnesium may represent a modifiable target for improving vascular access outcomes, warranting further prospective investigation.</p> Clinical trial number <p>This was a retrospective observational cohort study and was not registered as a clinical trial because no interventions were performed for research purposes.</p>

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Serum magnesium and risk of arteriovenous fistula thrombosis in hemodialysis: a retrospective cohort study

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  • 发表日期：

    2025年12月10日

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  • Natalia Stepanova,
  • Tetyana Ostapenko,
  • Andriy Rysyev,
  • Alina Holovanova,
  • Ihor Poperechnyi,
  • Anna Khizhyna,
  • Anastasiia Semeshyna,
  • Valeria Marchenko,
  • Mark Dyvynskyy

摘要

Background

Arteriovenous fistula (AVF) thrombosis is a major cause of vascular access failure in patients undergoing maintenance hemodialysis (HD). Although magnesium has established vascular protective properties, its relationship with AVF thrombosis remains poorly characterized. This study aimed to examine the association between serum magnesium levels and the risk of AVF thrombosis in a retrospective cohort of HD patients.

Methods

This bi-center retrospective cohort study included 408 HD patients treated between January 2020 and May 2025. Baseline serum magnesium was categorized into three thresholds based on the 25th and 75th percentiles of the cohort distribution: T1 ( < 0.87 mmol/L), T2 (0.87–0.97 mmol/L), and T3 (≥0.98 mmol/L). The primary outcome was the first clinically confirmed episode of AVF thrombosis. Kaplan–Meier analysis and multivariable Cox proportional hazard model adjusted for demographic, clinical, and dialysis-related factors were used to assess associations. Sensitivity and subgroup analyses were performed to evaluate the robustness of findings.

Results

Over a median follow-up of 33.5 months, 83 patients (20.3%) experienced AVF thrombosis. Compared to T1, patients in T2 and T3 groups had significantly lower thrombotic risk: HR 0.57 (95% CI: 0.40–0.82, p = 0.002) and HR 0.46 (0.28–0.77, p = 0.003), corresponding to a 1.75- and 2.17-fold higher risk for T1 versus T2 and T3, respectively. Independent predictors of increased AVF thrombosis risk included older age (HR 1.05 per year, 95% CI: 1.02–1.09), longer AVF duration (HR 1.02 per month, 95% CI: 1.007–1.08), higher serum phosphate (HR 1.11 per 0.1 mmol/L, 95% CI: 1.03–1.48), and use of calcium-based phosphate binders (HR 1.02, 95% CI: 1.003–1.27). Protective factors included male sex (HR 0.87, 95% CI: 0.54–0.98), higher dialysis adequacy (spKt/V; HR 0.16, 95% CI: 0.11–0.35) and statin therapy (HR 0.35, 95% CI: 0.14–0.86). The association between low magnesium and AVF thrombosis remained consistent in sensitivity and subgroup analyses.

Conclusions

Low serum magnesium (< 0.87 mmol/L) was independently associated with a twofold increased risk of AVF thrombosis in HD patients. Magnesium may represent a modifiable target for improving vascular access outcomes, warranting further prospective investigation.

Clinical trial number

This was a retrospective observational cohort study and was not registered as a clinical trial because no interventions were performed for research purposes.