Hepatitis C virus infection as a six-fold risk factor for hemostatic complications following arteriovenous fistula creation in end-stage renal disease: A seven-year prospective study

<ns3:p> Background Hepatitis C virus (HCV) infection demonstrates significantly elevated prevalence among hemodialysis populations worldwide, with particularly high rates in Middle Eastern countries. Despite this epidemiological pattern, limited evidence exists regarding the impact of HCV infection on hemostatic complications following arteriovenous fistula (AVF) creation in patients with end-stage renal disease (ESRD). Methods This prospective cohort study enrolled 460 patients diagnosed with ESRD requiring AVF creation at three tertiary hospitals in Baghdad, Iraq (Al-Yarmouk Teaching Hospital, Ibn-Al-Nafees Teaching Hospital, and Al-Shaheed Ghazi Al-Hariri Surgical Hospital), between January 2017 and January 2024. Patients were stratified by HCV serological status using third-generation enzyme-linked immunosorbent assay. The primary outcome was hemostatic complications (bleeding requiring intervention or clinically significant hematoma) monitored for six weeks postoperatively. Secondary outcomes included coagulation parameters, AVF maturation rates, and other vascular complications. Multivariate logistic regression identified independent predictors of complications. Results Among 460 patients, 151 (32.8%) tested positive for HCV. HCV-positive patients demonstrated significantly prolonged prothrombin time (19±5 versus 15±2.5 seconds, p&lt;0.001), activated partial thromboplastin time (40±4 versus 32±3 seconds, p&lt;0.001), and reduced platelet count (153±43 versus 215±72 ×10 <ns3:sup>3</ns3:sup> /mm <ns3:sup>3</ns3:sup> , p&lt;0.001). Hemostatic complications occurred in 28.5% of HCV-positive patients compared to 5.5% of HCV-negative patients (crude OR: 6.835, 95% CI: 3.597-12.987, p&lt;0.001). In multivariate analysis, HCV infection emerged as the strongest independent predictor of hemostatic complications (adjusted OR: 5.892, 95% CI: 3.102-11.196, p&lt;0.001). AVF maturation rates were significantly lower in HCV-positive patients (74.2% versus 86.4%, p=0.002). Conclusions Hepatitis C virus infection increases hemostatic complications following AVF creation nearly six-fold and adversely affects fistula maturation rates. These findings emphasize the importance of incorporating HCV status into preoperative risk stratification and perioperative management protocols, particularly in high-prevalence regions. </ns3:p>