ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cytokines and Soluble Mediators in Immunity
This article is part of the Research TopicCytokines in inflammatory, infectious and noninfectious diseasesView all 10 articles
Plastic cannulas mitigate arteriovenous fistula stenosis by suppressing the CFB-mediated inflammatory cascade
Provisionally accepted
- 1The 981st Hospital of the Chinese People's Liberation Army Joint Logistics Support Force, Chengde, China
- 2Shenzhen Baoan District People's Hospital Department of Ultrasound, Shenzhen, China
- 3Harbin University, Harbin, China
- 4People's Liberation Army Beidaihe Rest and Recuperation Center, Qinhuangdao, China
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Background: The choice of an appropriate cannulation technique should be important to increase the possibility of better outcomes in terms of arteriovenous fistulas (AVF) survival and comfort of the patient undergoing hemodialysis. Methods: It is a retrospective study and microarray analysis was conducted to identify differentially expressed genes (DEGs) between failing and control access samples. Sixty-four patients who underwent early cannulation (3–4 weeks after AVF creation) were enrolled and divided into two groups: a plastic cannula group (n = 33) and a metal needle group (n = 31). Comparisons were made between the groups regarding complement components, blood flow, access intimal hyperplasia, and inflammatory cell infiltration. Results: (1) AVF failure occurred in 13 patients (20.3%) over a mean follow-up of 242 ± 105 days. (2) Complement B factor (CFB) levels showed significant changes within the first two weeks post-cannulation. (3) Fluctuations in CFB strongly correlated with changes in AVF blood flow during follow-up. (4) CFB variation independently predicted AVF failure, with a hazard ratio of 4.54 (95% CI, 1.21– 16.99). (5) The plastic cannula group exhibited significantly lower CFB expression in both blood and outflow access, along with marked improvements in intimal hyperplasia and inflammatory cell infiltration. (6) Compared with the metal needle group, serum from the plastic cannula more significantly induced endothelial cell proliferation and nitric oxide production, with CFB playing a critical role. Conclusions: The alternative complement pathway is significantly activated during initial AVF cannulation, with excessive CFB production contributing substantially to AVF failure. The use of plastic cannulas may improve long-term AVF patency by mitigating endothelial dysfunction and inhibiting inflammatory cell infiltration through suppression of CFB generation.
Keywords: Arteriovenous Fistula, complement, Early cannulation, failure, cannulation device
Received: 29 Sep 2025; Accepted: 18 Nov 2025.
Copyright: © 2025 Zhang, Kong, Zhao, Ou, Ma, Qi and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yang Yang, yybjzy@163.com
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