Elevated serum TMAO levels associate with higher risk of arteriovenous vascular access thrombosis in hemodialysis patients

Background: -oxide (TMAO), a gut microbiota-derived metabolite that accumulates in kidney failure and exhibits prothrombotic properties, has been linked to cardiovascular events in dialysis populations. Its relevance to dialysis arteriovenous access outcomes, however, remains unclear. Methods: We conducted a multicenter prospective cohort study including 375 adult patients undergoing maintenance hemodialysis at 12 centers in Taiwan. Baseline serum TMAO concentrations were measured using liquid chromatography-tandem mass spectrometry and analyzed as tertiles and as a log-transformed continuous variable. Participants were followed for a median of 24 months. The primary outcome was time to first arteriovenous access thrombosis. Associations were evaluated using Cox proportional hazards models with multivariable adjustment and restricted cubic spline analyses. Results: = .051). Conclusion: Higher serum TMAO levels were independently associated with an increased risk of arteriovenous access thrombosis in patients undergoing hemodialysis. These findings suggest that TMAO reflects a systemic prothrombotic milieu relevant to dialysis arteriovenous access and support further studies to determine whether TMAO represents a modifiable pathway or a biomarker of uremic thrombotic susceptibility.