An arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis in chronic kidney disease (CKD) patients but is often complicated by stenosis. AVF stenosis arises primarily from neointimal hyperplasia, driven by smooth muscle cell proliferation and migration. Matrix metalloproteinase-9 (MMP-9) plays a key role in this process by degrading extracellular matrix proteins and facilitating neointimal hyperplasia. This study aimed to explore the association between MMP-9 levels and AVF stenosis in CKD patients. A cross-sectional study was conducted on CKD patients undergoing hemodialysis with AVF between July 2021 and January 2024. Plasma MMP-9 levels were measured using enzyme-linked immunosorbent assay and chromogenic peptide substrate assay. AVF stenosis was assessed through physical examination, duplex ultrasonography, and/or catheter angiography. Diagnostic value was determined using receiver operating characteristic curve analysis, and associations were analyzed using bivariate and multivariate models. Among 51 patients, 29 had AVF stenosis, and 22 had patent AVF. Plasma MMP-9 levels were significantly higher in the stenosis group (1384.2 ng/mL [801–4822]) compared with the patent group (743.4 ng/mL [122–3195.6]; p = 0.001). An MMP-9 cutoff of 962.2 ng/mL yielded an area under the curve of 83.3% (95% confidence interval [CI]: 0.71–0.95). MMP-9 levels were significantly associated with stenosis (p = 0.001, odds ratio [OR]: 7.00, 95% CI: 2.02–24.25), corroborated by multivariate analysis (p = 0.013, OR: 8.692, 95% CI: 1.575–47.986). Another associated factor for stenosis was radiocephalic AVF location (p = 0.002, OR: 16.618, 95% CI: 2.9–92.221). High MMP-9 levels were associated with AVF stenosis in CKD patients, suggesting MMP-9 as a potential biomarker for early AVF stenosis detection.

This study was conducted in compliance with the ethical guidelines outlined in the Ethical Clearance Letter (KE/FK/0343/2021) issued by the Biomedical Research Ethics Committee of the Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada-Dr. Sardjito General Hospital, with continuing review and amendment approval number KE/FK/1060/2023.

Informed consent was obtained from all participants involved in this study. The participants were provided with detailed information about the study's purpose, procedures, risks, and benefits, and written consent was acquired prior to their participation.

M.T.I., H.H., Y.W., and M.P. contributed to the study concept and final manuscript review. M.T.I., J.S., T.T., Y.W., and L.A. executed the study, whereas A.R., R.T., and N.A. conducted data analysis. I.P.A.A., G.R., B.K., and D.N. contributed to interpret the results and prepare the manuscript. All authors have reviewed and approved the final version of the manuscript.

Article published online:
06 May 2026

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