To determine the diagnostic value of IMR towards AVF nonmaturation, ROC curve analysis was performed.It showed the range of IMR was 0.2 to 0.6 which had strong predictive ability for AVF nonmaturation (AUC-0.879).IMR was further stratified in to four categories-(a).less than 0.2, (b).0.2-0.3,(c).0.3-0.4 and (d).0.4-0.6.Analysis of this revealed AVFs with venous IMR of less than 0.3matured successfully.The IMR of 0.36 has shown the highest sensitivity (80.5%) and moderate specificity (73.9%), towards AVF non-maturation.The curves demonstrated high sensitivity at low falsepositive rates and remained well-separated from the reference line, confirming its strong, non-random association with AVF failure (Figure 4a, 4b, 4c and 4d); (Table 5). Conclusion:This study is the first to demonstrate a strong association between AVF non-maturation and venous remodeling, quantitatively assessed through histo-morphometry in non-diabetic CKD patients.Pre-existing intimal hyperplasia, medial fibrosis, and elevated intimamedia ratio (IMR) were identified as the main histological predictors of failure.Complementary Doppler findings showed that altered wall shear stress (WSS) and a low ankle-brachial index (ABI < 0.9) were associated with increased non-maturation risk, highlighting the interplay between vessel structure and hemodynamics.Most participants were middle-aged; age had little effect due to the exclusion of elderly patients.Fewer females were included because of suboptimal vessel quality, but outcomes did not differ by sex, aligning with previous reports (3,5,14).Hypertension offered no advantage for maturation and may instead impair it by promoting vascular stiffness and endothelial dysfunction (5,6,15,16).Biochemical variables such as hemoglobin, calcium, and creatinine were not associated with outcomes, reaffirming that local vascular and hemodynamic factors play a greater role than systemic parameters.Serum phosphorus also showed no correlation with non-maturation, consistent with the HFM study (14,17).Elevated iPTH, though not statistically significant, may contribute to stiffness and calcification, indirectly affecting remodeling (9,17).Preoperative arterial and venous diameters did not predict maturation, indicating that vascular function depends more on compliance and distensibility than size.Patients with non-matured AVFs had lower ABI values, suggesting underlying arterial disease.Though not significant due to sample size, ABI may serve as a simple noninvasive screening marker (18-20).Postoperative Doppler parameters-blood flow and venous diameter-were strongly associated with maturation by 12 weeks, reflecting time-dependent remodeling (4,14).
Yata et al. (Wed,) studied this question.