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논문분류	춘계학술대회 초록집
제목	Lipid Profiles and Early Outcomes of Arteriovenous Access in Hemodialysis Patients
저자	Ji Eun Kim
출판정보	2026; 2026(1):
키워드	Early access dysfunction, AV access, PTA, restenosis, thrombosis
초록	Objectives: In end-stage renal disease (ESRD), traditional cardiovascular risk factors exhibit paradoxical associations with outcomes due to malnutrition-inflammation complex syndrome. Non-HDL cholesterol has been linked to cardiovascular mortality in dialysis patients, yet its impact on arteriovenous (AV) access outcomes remains poorly defined. Methods: We conducted a single-center retrospective cohort study of 1,587 hemodialysis patients who underwent arteriovenous fistula (AVF) or graft (AVG) creation between January 2010 and June 2025. Patients with a lipid profile measured within 6 months before access creation were included. Time to first PTA was analyzed using Cox proportional hazards models with restricted cubic splines to characterize non-linear lipid effects. Early access events—PTA ≤6 months, thrombectomy ≤6 months, and restenosis ≤3 months—were analyzed using logistic regression with non-HDL cholesterol categorized into quintiles. Results: Mean age was 65.0±13.9 years; 75.1% had diabetes mellitus. During follow-up, 526 PTA events occurred (14.04/100 person-years). Early PTA occurred in 307 patients (19.3%), early thrombectomy in 17 (1.1%), and early restenosis in 194 (12.2%). Spline analyses revealed a non-linear inverse association between non-HDL cholesterol and PTA risk, with the highest risk in the lowest non-HDL range. Patients in the lowest non-HDL quintile (Q1) had significantly higher odds of early PTA (adj OR 1.54, 95% CI 1.03–2.31, p=0.036) and early restenosis (adj OR 1.91, 95% CI 1.17–3.18, p=0.011) versus Q3 (Table 1). This association was confined to early events (≤6 months) and was absent for late PTA (>6 months). No significant interaction was found between non-HDL quintiles and albumin status for either outcome. Conclusion: Low non-HDL cholesterol was independently associated with early AV access dysfunction, including early PTA and restenosis, in hemodialysis patients. This association was not mediated by hypoalbuminemia, suggesting low non-HDL may reflect systemic frailty or altered lipid metabolism beyond malnutrition. Prospective studies are warranted to clarify the underlying mechanisms.
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