Retrospective analysis of statin use and arteriovenous fistula thrombosis in hemodialysis: Is there a dose-dependent effect?

Natalia  Stepanova; Tetyana Ostapenko; Valeriia  Marchenko; Alina  Holovanova; Mariia  Lysii; Tetyana  Kucher; Viacheslav  Filonov; Victor  Dzhur; Bohdan  Stetsenko; Hanna  Moroid; Nataliia  Pavchak; Kateryna  Rusyn; Oksana  Rusyn; Bohdan  Radiuk

doi:10.31450/ukrjnd.2(86).2025.03

Natalia Stepanova State Institution “O.O. Shalimov National Scientific Center of Surgery and Transplantology of the National Academy of Medical Science of Ukraine,” Kyiv, Ukraine; Medical Center “Nephrocenter,” Kyiv, Ukraine https://orcid.org/0000-0002-1070-3602
Tetyana Ostapenko Medical Center “Nephrocenter,” Zaporizhzhia, Ukraine https://orcid.org/0000-0002-6256-2645
Valeriia Marchenko Medical Center “Nephrocenter,” Zaporizhzhia, Ukraine https://orcid.org/0000-0003-1892-6277
Alina Holovanova Medical Center “Nephrocenter,” Zaporizhzhia, Ukraine https://orcid.org/0009-0002-3959-9383
Mariia Lysii Medical Center “Nephrocenter,” Stryi, Ukraine
Tetyana Kucher Medical Center “Nephrocenter,” Sarny, Ukraine
Viacheslav Filonov Medical Center “Nephrocenter,” Odesa, Ukraine
Victor Dzhur Medical Center “Nephrocenter,” Kyiv, Ukraine
Bohdan Stetsenko Medical Center “Nephrocenter,” Kyiv, Ukraine
Hanna Moroid Medical Center “Nephrocenter,” Sheptytskyi, Ukraine
Nataliia Pavchak Medical Center “Nephrocenter,” Drohobych, Ukraine
Kateryna Rusyn Medical Center “Nephrocenter,” Lviv, Ukraine
Oksana Rusyn Medical Center “Nephrocenter,” Lviv, Ukraine
Bohdan Radiuk Medical Center “Nephrocenter,” Gorodok, Ukraine

DOI: https://doi.org/10.31450/ukrjnd.2(86).2025.03

Keywords: hemodialysis, arteriovenous fistula, thrombosis, statins, risk, treatment.

Abstract

Arteriovenous fistula (AVF) thrombosis is a major vascular access complication in hemodialysis (HD) patients, contributing to increased morbidity. Statins, known for their pleiotropic effects, may reduce AVF thrombosis risk, but evidence on dose-dependent effects is limited. This study evaluated the association between statin use, dose intensity, and AVF thrombosis in HD patients.

Methods. A multicenter, retrospective cohort study was conducted using data from 562 HD patients with native AVFs across 10 dialysis clinics (May 2021–April 2025). Patients were categorized by statin use (users vs. non-users) and dose intensity (moderate vs. high vs. none). The primary outcome was AVF thrombosis; death was treated as a competing event. Kaplan-Meier survival curves and Fine and Gray subdistribution hazard models, adjusted for age, diabetes, dialysis vintage, Kt/V, glucose, calcium, blood flow, and pre-HD cardiovascular disease, were used to assess thrombosis risk.

Results. Of 562 patients (median follow-up 59 months), 212 (37.7%) were statin users. AVF thrombosis occurred in 54 (9.6%) patients, with 11 (7.1%) in statin users vs. 43 (10.6%) in non-users (p = 0.006). Kaplan-Meier analysis showed lower thrombosis probability in statin users (log-rank p = 0.001), with high-intensity users having the lowest risk (p = 0.004). In the unadjusted Fine and Gray model, high-intensity statins were associated with reduced thrombosis risk (sHR 0.61, 95% CI 0.59–0.97, p = 0.03), with a significant dose-dependent trend (p = 0.018). The adjusted model showed no significant association (moderate: sHR 0.67, p = 0.16; high: sHR 0.57, p = 0.26).

Conclusions. Statin use, particularly high-intensity, may reduce AVF thrombosis risk in HD patients, with a dose-dependent trend in unadjusted analyses. However, adjusted results were non-significant, possibly due to limited events. Larger prospective studies are needed to confirm these findings and optimize statin therapy for vascular access preservation.