Introduction: Arteriovenous fistula (AVF) serves as the preferred vascular access for hemodialysis.However, AVF failure remains a major complication, often linked to arterial calcification and vascular stiffness.Osteoprotegerin (OPG), a soluble decoy receptor of the tumor necrosis factor (TNF) superfamily, has been implicated in vascular calcification and may contribute to AVF dysfunction.This study aimed to evaluate the association between serum OPG, arterial calcification, and AVF failure in CKD patients undergoing hemodialysis.Methods: A systematic review and meta-analysis were conducted according to PRISMA guidelines.Comprehensive searches were performed in PubMed and ScienceDirect for studies published up to October 1, 2024, using keywords related to osteoprotegerin, arteriovenous fistula, calcification, and chronic kidney disease.Eligible studies included adult CKD or ESKD patients on hemodialysis that assessed serum OPG levels, arterial or vascular calcification, and AVF outcomes.Data were extracted using standardized forms, and risk of bias was assessed using the Newcastle-Ottawa Scale.Pooled analyses were performed using random-effects models in Review Manager 5, and heterogeneity was evaluated with I 2 statistics.Results: Twenty-one studies met inclusion criteria.Eleven studies examined the association between OPG and arterial calcification in CKD patients, consistently showing higher OPG levels among those with calcification.Meta-analysis of four studies demonstrated that the calcification group had significantly elevated serum OPG levels (SMD = 0.72, 95% CI 0.30-1.14,p = 0.0009; I 2 = 74%).Six studies explored arterial calcification and AVF failure; pooled analysis of four studies revealed that patients with arterial calcification were nearly three times more likely to experience AVF failure (OR = 2.98, 95% CI 1.78-4.99,p < 0.0001; I 2 = 68%).Only three studies directly assessed OPG and AVF failure.One study reported significantly higher OPG levels in AVF thrombosis (HR = 5.52, p = 0.005), while two studies found no significant associations.The pooled mean difference was not significant (MD = 77.1 -117.9-272.1;p = 0.44; I 2 = 86%).Conclusion: Elevated serum OPG is associated with arterial calcification, and arterial calcification significantly increases the risk of AVF failure in hemodialysis patients.However, evidence linking OPG directly to AVF failure remains inconsistent and limited by small sample sizes and heterogeneity across studies.Further well-designed prospective and case-control studies are needed to clarify the causal pathway and validate OPG as a predictive biomarker for AVF outcomes in CKD.I have no potential conflict of interest to disclose.I did not use generative AI and AI-assisted technologies in the writing process.
Kitano et al. (Wed,) studied this question.