# Gender Disparities in Secondary Patency of Arteriovenous Fistulas: Insights into Hemodialysis Outcomes and Long-Term Vascular Access Viability

## TL;DR

This study finds that women, especially those postmenopausal, have lower long-term success rates with hemodialysis vascular access compared to men.

## Contribution

The study identifies gender as an independent predictor of reduced long-term secondary patency in arteriovenous fistulas.

## Key findings

- Female patients had lower primary patency rates compared to males at 1, 3, and 5 years.
- Postmenopausal women showed significantly reduced long-term AVF patency.
- Early risk factor optimization is crucial to improve vascular access outcomes in high-risk patients.

## Abstract

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–Meier 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.