{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T06:07:15Z","timestamp":1788934035502,"version":"build-2803163510"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis, yet up to 50% of AVFs fail within the first year due to stenosis or thrombosis. The high-sensitivity C-reactive protein to albumin ratio (HRR) integrates inflammation and nutritional status, but its association with AVF failure has not been systematically evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study included 279 patients who underwent first-time AVF creation. HRR was calculated as hsCRP (mg\/L) divided by albumin (g\/L). The primary outcome was AVF failure (stenosis \u226550% or thrombosis requiring intervention). Multivariate Cox regression adjusted for age, sex, BMI, diabetes, hypertension, smoking, and vessel diameter. Model performance was assessed using time-dependent ROC, calibration curve, and decision curve analysis (DCA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During a median follow-up of 50 months, 141 patients (50.5%) developed AVF failure.In multivariate analysis, higher HRR was independently associated with increased AVF failure risk (HR per unit increase\u2009=\u20091.65, 95% CI: 1.33\u20132.05,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001), independent of vessel diameter (HR\u2009=\u20090.21, 95% CI: 0.08\u20130.57,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.002). A landmark analysis stratified at 24 months demonstrated that the predictive effect of HRR was directionally consistent across early (HR\u2009=\u20091.60, 95% CI: 1.27\u20132.02) and late (HR\u2009=\u20091.47, 95% CI: 0.66\u20133.29) follow-up periods (\n                      <jats:italic>P<\/jats:italic>\n                      for interactio\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20090.766), although the late-phase estimate was imprecise due to the reduced sample size. The model demonstrated moderate discrimination at 24 months (AUC\u2009=\u20090.608, 95% CI: 0.519\u20130.701) and good calibration. DCA confirmed that incorporating HRR provided positive net clinical benefit across clinically relevant threshold probabilities. The proportional hazards assumption was satisfied (global\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.97). Sensitivity analysis using multiple imputation yielded consistent results.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Preoperative HRR is an independent predictor of AVF failure. Although the model demonstrated weak to moderate discrimination (24-month AUC\u2009=\u20090.608), decision curve analysis confirmed a positive net clinical benefit, supporting its potential utility in preoperative risk stratification. This simple, widely available laboratory-based marker may assist clinicians in identifying high-risk patients and individualizing surveillance intensity, though external validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1922562","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T05:49:54Z","timestamp":1788932994000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative high-sensitivity C-reactive protein-to-albumin ratio predicts arteriovenous fistula failure in hemodialysis patients: a retrospective cohort study with landmark analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Shanshan","family":"Huo","sequence":"first","affiliation":[{"name":"Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, Hubei, 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