Background: Observational and mechanistic studies have linked glycated hemoglobin (HbA1c) and cardiac troponin I (cTnI) to chronic inflammation and thrombosis. We explored how these two routinely available biomarkers relate to arteriovenous fistula (AVF) thrombosis in maintenance hemodialysis (MHD), and quantified their predictive value singly and in combination.

Methods: We reviewed 236 patients with consecutive end-stage renal disease (ESRD) who underwent autogenous AVF creation between January 2021 and June 2023. Baseline demographic, clinical and biochemical variables were recorded. Logistic regression (univariate then multivariate) identified independent correlates of thrombosis. Using the final model, we built a nomogram and evaluated its performance using receiver operating characteristic (ROC) analysis, calibration behavior and decision curve analysis (DCA).

Results: Within 12 months, 25 patients (10.6%) met criteria for AVF thrombosis. Four variables remained independently associated with events: C-reactive protein (CRP) ≥10 mg/L, intradialytic hypotension, HbA1c ≥6.5%, and cTnI ≥0.2 μg/L (all p < 0.05). A nomogram combining these factors demonstrated good discriminative ability (area under the curve [AUC] 0.850; 95% CI 0.741–0.960) and showed acceptable calibration (Hosmer–Lemeshow p = 0.244).

Conclusion: HbA1c and cTnI may serve as sensitive markers for postoperative AVF thrombosis in hemodialysis patients, facilitating earlier risk identification, preventive measures, and timely intervention. Their predictive performance is further enhanced when combined with CRP and intradialytic hypotension.