{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T16:03:32Z","timestamp":1772121812001,"version":"3.50.1"},"reference-count":44,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Autologous arteriovenous fistulas (AVFs) are the preferred vascular access modality for hemodialysis due to superior durability and lower infection rates. However, long-term secondary functional patency remains a critical determinant of dialysis success and patient survival. Although sex-related differences in vascular access outcomes have been reported, their impact on long-term secondary patency remains insufficiently clarified. Objective: The primary objective of this study was to evaluate long-term gender differences in the secondary functional patency of AVFs and to determine clinical, anatomical, and procedural factors contributing to these disparities. Methods: A retrospective cohort study including 968 ESRD patients undergoing AVF creation between 2012 and 2024 was conducted. Secondary patency was analyzed using Kaplan\u2013Meier survival curves. Multivariate logistic regression identified independent predictors. The overall primary functional patency rates were 78.9% at 1 year, 71.2% at 3 years, and 62.7% at 5 years. When stratified by gender, male patients demonstrated primary patency rates of 80.3% at 1 year, 72.8% at 3 years, and 64.5% at 5 years, whereas female patients showed slightly lower rates of 77.3% at 1 year, 69.4% at 3 years, and 60.6% at 5 years. Conclusions: Female gender, particularly in the postmenopausal period, is an independent determinant of reduced long-term secondary AVF patency. Early identification of high-risk patients and structured risk factor optimization are essential to improve vascular access durability.<\/jats:p>","DOI":"10.3390\/jcm15051777","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T14:51:29Z","timestamp":1772117489000},"page":"1777","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gender Disparities in Secondary Patency of Arteriovenous Fistulas: Insights into Hemodialysis Outcomes and Long-Term Vascular Access Viability"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7767-9029","authenticated-orcid":false,"given":"Lutfi \u00c7agatay","family":"Onar","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, Republic of Turkey, Ministry of Health, Dr. \u0130smail Fehmi Cumalioglu City Hospital, Tekirdag 59020, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Didem Melis","family":"Oztas","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Vadistanbul Liv Hospital, Istanbul 34475, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murat","family":"Ugurlucan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, Vadistanbul Liv Hospital, Istanbul 34475, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1038\/s41581-020-0333-2","article-title":"Challenges and novel therapies for vascular access in haemodialysis","volume":"16","author":"Lawson","year":"2020","journal-title":"Nat. Rev. Nephrol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e27237","DOI":"10.1097\/MD.0000000000027237","article-title":"Top 100 cited articles on hemodialysis: A bibliometric analysis","volume":"100","author":"Lee","year":"2021","journal-title":"Medicine"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"577","DOI":"10.46747\/cfp.6808577","article-title":"Overview of hemodialysis access and assessment","volume":"68","author":"Arasu","year":"2022","journal-title":"Can. Fam. Physician"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2827","DOI":"10.1681\/ASN.2017060663","article-title":"Moving Beyond the Assumed: Improving Fistula Success Rates","volume":"28","author":"Wish","year":"2017","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"310","DOI":"10.23736\/S0392-9590.18.03927-5","article-title":"Predictors of early failure and secondary patency in native arteriovenous fistulas for hemodialysis","volume":"37","author":"Abreu","year":"2018","journal-title":"Int. Angiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1177\/11297298211002574","article-title":"Factors associated with functional arteriovenous fistula at hemodialysis start and arteriovenous fistula non-use in a single-center cohort","volume":"23","author":"Chung","year":"2022","journal-title":"J. Vasc. Access"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1330","DOI":"10.1093\/ndt\/gfw220","article-title":"Association between vascular access creation and deceleration of estimated glomerular filtration rate decline in late-stage chronic kidney disease patients transitioning to end-stage renal disease","volume":"32","author":"Sumida","year":"2017","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1007\/s12055-022-01390-7","article-title":"Early and midterm patency of arteriovenous fistula for hemodialysis access using different techniques and their advantages and disadvantages","volume":"38","author":"Goyal","year":"2022","journal-title":"Indian. J. Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"13287","DOI":"10.1038\/s41598-024-64075-8","article-title":"Heterogeneous gene expression during early arteriovenous fistula remodeling suggests that downregulation of metabolism predicts adaptive venous remodeling","volume":"14","author":"Ohashi","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"H77","DOI":"10.1152\/ajpheart.00049.2023","article-title":"Sex hormones impact early maturation and immune response in the arteriovenous fistula mouse model","volume":"325","author":"Satam","year":"2023","journal-title":"Am. J. Physiol. Heart Circ. Physiol."},{"key":"ref_11","first-page":"235","article-title":"Expert Group of Nephrology Branch of China Academy of Chronic Disease Urology Nephrology and Blood Purification Commission of China Medical Education Association. Expert consensus on the establishment and maintenance of native arteriovenous fistula","volume":"7","author":"Zhang","year":"2021","journal-title":"Chronic Dis. Transl. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e20230052","DOI":"10.1590\/1677-5449.202300522","article-title":"Guidelines on vascular access for hemodialysis from the Brazilian Society of Angiology and Vascular Surgery","volume":"22","author":"Harduin","year":"2023","journal-title":"J. Vasc. Bras."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1016\/j.jvs.2015.04.451","article-title":"The influence of cephalic vein diameter and diabetes on primary maturation and patency of autogenous radiocephalic arteriovenous fistulas","volume":"62","author":"Park","year":"2015","journal-title":"J. Vasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.avsg.2020.08.109","article-title":"Maturation Rates of Arteriovenous Fistulas Using Small Veins in the Era of Endovascular Interventions","volume":"71","author":"Wang","year":"2021","journal-title":"Ann. Vasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"33","DOI":"10.4103\/VIT.VIT_9_19","article-title":"Molecular Targets for Improving Arteriovenous Fistula Maturation and Patency","volume":"2","author":"Gorecka","year":"2019","journal-title":"Vasc. Investig. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Yan, R., Song, A., and Zhang, C. (2024). The Pathological Mechanisms and Therapeutic Molecular Targets in Arteriovenous Fistula Dysfunction. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25179519"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bekric, D., Kiesslich, T., Ocker, M., Winklmayr, M., Ritter, M., Dobias, H., Beyreis, M., Neureiter, D., and Mayr, C. (2024). The efficacy of ferroptosis-inducing compounds IKE and RSL3 correlates with the expression of ferroptotic pathway regulators CD71 and SLC7A11 in biliary tract cancer cells. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0302050"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1007\/s00109-021-02056-4","article-title":"Sterile inflammation in the pathogenesis of maturation failure of arteriovenous fistula","volume":"99","author":"Nguyen","year":"2021","journal-title":"J. Mol. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1177\/089686089501500210","article-title":"Comparison of peritoneal catheter survival with fistula survival in hemodialysis","volume":"15","author":"Kim","year":"1995","journal-title":"Perit. Dial. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.avsg.2019.08.083","article-title":"Gender-Based Utilization and Outcomes of Autogenous Fistulas and Prosthetic Grafts for Hemodialysis Access","volume":"65","author":"Arhuidese","year":"2020","journal-title":"Ann. Vasc. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1093\/ckj\/sfaa132","article-title":"Alberta Kidney Disease Network Sex differences in the vascular access of hemodialysis patients: A cohort study","volume":"14","author":"MacRae","year":"2020","journal-title":"Clin. Kidney J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/S1550-8579(07)80040-4","article-title":"Gender differences in vascular access in hemodialysis patients in the United States: Developing strategies for improving access outcome","volume":"4","author":"Marcus","year":"2007","journal-title":"Gend. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"313","DOI":"10.4103\/1319-2442.202759","article-title":"Factors influencing patency of Brescia-Cimino arteriovenous fistulas in hemodialysis patients","volume":"28","author":"Manne","year":"2017","journal-title":"Saudi J. Kidney Dis. Transpl."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1080\/08860220600583617","article-title":"Primary arteriovenous fistulas in the forearm for hemodialysis: Effect of miscellaneous factors in fistula patency","volume":"28","author":"Erkut","year":"2006","journal-title":"Ren. Fail."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1016\/j.jvs.2011.07.095","article-title":"Factors affecting the patency of arteriovenous fistulas for dialysis access","volume":"55","author":"Smith","year":"2012","journal-title":"J. Vasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1053\/j.ajkd.2020.11.022","article-title":"Efficacy and Safety of Paclitaxel-Coated Balloon Angioplasty for Dysfunctional Arteriovenous Fistulas: A Multicenter Randomized Controlled Trial","volume":"78","author":"Yin","year":"2021","journal-title":"Am. J. Kidney Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.1016\/j.jvs.2019.07.090","article-title":"A randomized controlled trial of drug-coated balloon angioplasty in venous anastomotic stenosis of dialysis arteriovenous grafts","volume":"71","author":"Liao","year":"2020","journal-title":"J. Vasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"103","DOI":"10.5301\/jva.5000508","article-title":"Systematic review of drug eluting balloon angioplasty for arteriovenous haemodialysis access stenosis","volume":"17","author":"Khawaja","year":"2016","journal-title":"J. Vasc. Access"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1053\/j.semvascsurg.2016.08.002","article-title":"Drug-coated balloon angioplasty for dialysis access fistula stenosis","volume":"29","author":"Boitet","year":"2016","journal-title":"Semin. Vasc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"233","DOI":"10.21037\/cdt-22-497","article-title":"Choosing the right treatment for the right lesion, Part II: A narrative review of drug-coated balloon angioplasty and its evolving role in dialysis access maintenance","volume":"13","author":"DePietro","year":"2023","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"112","DOI":"10.21037\/cdt-23-25","article-title":"Endovascular and surgical interventions in the end-stage renal disease population","volume":"13","author":"Partovi","year":"2023","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s13239-017-0323-0","article-title":"Biological and Physical Factors Involved in the Maturation of Arteriovenous Fistula for Hemodialysis","volume":"8","author":"Remuzzi","year":"2017","journal-title":"Cardiovasc. Eng. Technol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1007\/s13239-017-0322-1","article-title":"Towards the Identification of Hemodynamic Parameters Involved in Arteriovenous Fistula Maturation and Failure: A Review","volume":"8","author":"Franzoni","year":"2017","journal-title":"Cardiovasc. Eng. Technol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"E21","DOI":"10.3171\/2019.5.FOCUS19234","article-title":"Flow-induced, inflammation-mediated arterial wall remodeling in the formation and progression of intracranial aneurysms","volume":"47","author":"Cebral","year":"2019","journal-title":"Neurosurg. Focus"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1016\/j.jvs.2011.05.005","article-title":"Influence of diabetes and perivascular allogeneic endothelial cell implants on arteriovenous fistula remodeling","volume":"54","author":"Conte","year":"2011","journal-title":"J. Vasc. Surg."},{"key":"ref_36","first-page":"e62298","article-title":"Association Between Atherosclerotic Cardiovascular Disease (ASCVD) Risk Score and Arteriovenous Fistula Failure in Patients on Maintenance Hemodialysis","volume":"16","author":"Gajashree","year":"2024","journal-title":"Cureus"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"255","DOI":"10.4174\/astr.2024.106.5.255","article-title":"Predicting factors for early failure of vascular access in hemodialysis patients","volume":"106","author":"Kim","year":"2024","journal-title":"Ann. Surg. Treat. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1177\/11297298221116236","article-title":"Impact of COVID-19 pandemic on hemodialysis access thrombosis","volume":"25","author":"Cho","year":"2024","journal-title":"J. Vasc. Access."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1053\/j.ajkd.2017.09.012","article-title":"International Differences in the Location and Use of Arteriovenous Accesses Created for Hemodialysis: Results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"71","author":"Pisoni","year":"2018","journal-title":"Am. J. Kidney Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1053\/j.ajkd.2017.12.004","article-title":"Lessons from International Differences in Vascular Access Practices and Outcomes","volume":"71","author":"Allon","year":"2018","journal-title":"Am. J. Kidney Dis."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"4772","DOI":"10.1038\/s41598-021-84444-x","article-title":"Adventitial delivery of nanoparticles encapsulated with 1\u03b1, 25-dihydroxyvitamin D3 attenuates restenosis in a murine angioplasty model","volume":"11","author":"Cai","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"33159","DOI":"10.1021\/acsami.4c06042","article-title":"Controlled Delivery of Rosuvastatin or Rapamycin through Electrospun Bismuth Nanoparticle-Infused Perivascular Wraps Promotes Arteriovenous Fistula Maturation","volume":"16","author":"Barcena","year":"2024","journal-title":"ACS Appl. Mater. Interfaces"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"214052","DOI":"10.1016\/j.bioadv.2024.214052","article-title":"Bismuth-infused perivascular wrap facilitates delivery of mesenchymal stem cells and attenuation of neointimal hyperplasia in rat arteriovenous fistulas","volume":"166","author":"Barcena","year":"2025","journal-title":"Biomater. Adv."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"eadp7723","DOI":"10.1126\/scitranslmed.adp7723","article-title":"Periadventitial delivery of mesenchymal stem cells improves vascular remodeling and maturation in arteriovenous fistulas","volume":"17","author":"Kilari","year":"2025","journal-title":"Sci. Transl. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1777\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:08:26Z","timestamp":1772118506000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1777"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":44,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051777"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051777","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]}}}