Impact of arteriovenous fistula blood flow on serum il-6, cardiovascular events and death: An ambispective cohort analysis of 64 Chinese hemodialysis patients
Impact of arteriovenous fistula blood flow on serum il-6, cardiovascular events and death: An ambispective cohort analysis of 64 Chinese hemodialysis patients
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动静脉内瘘血流对血清IL-6、心血管事件和死亡的影响：64名中国血液透析患者的双向队列分析
DOI：
10.1371/journal.pone.0172490
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发表时间：
2017-03-07
期刊：
影响因子：
3.7
通讯作者：
Xu, Gang
中科院分区：
文献类型：
--
作者：
Hu, Zhizhi;Zhu, Fengmin;Xu, Gang
动静脉瘘(AVF)的流量(Qa)影响血液透析(HD)患者的透析充分性。然而，关于长期透析患者，特别是中国患者，不同通道流量水平的结果的数据有限。在此，我们进行了一项双视角、单中心的队列研究，调查了2009-2015年间中国血液透析患者发生放射性头瘘(AVF)后，AVF血流与炎症、心血管事件和死亡之间的关系。23例患者(35.9%)在AVF发生后两年内至少发生一次心血管疾病(CVD)。脑血管病患者的AVF Qa、IL-6和hsCRP水平明显高于非脑血管病患者。多因素二元Logistic回归分析发现，血清IL-6是影响血液透析患者心脑血管病变的独立和最强的危险因素，且血清IL-6水平与血透患者AVF Qa水平呈正相关。因此，在五年的中位随访期内，研究了心动过速与不良临床结果(心血管事件和死亡率)之间的联系。高aVF Qa(>；1027.13 m l/m in)组IL-6水平显著升高。AVF Qa中位数的患者心脑血管疾病的发病率和死亡率最低，而较高的Qa与较高的心血管疾病风险相关，较低的aVF Qa(600ml/m in≤，821.12 m l/m in)有较高的非心血管死亡风险。因此，将心动过速QA维持在最佳水平(821.12~1027.13毫升/分钟)将有利于HD患者，改善长期临床结局，降低心动过速所致的炎症反应。
Flows (Qa) of arteriovenous fistula (AVF) impact the dialysis adequacy in hemodialysis (HD) patients. However, data for different access flow levels on outcomes related to long-term dialysis patients, especially in Chinese patients, are limited. Herein, we performed an ambispective, mono-centric cohort study investigating the association between the AVF flows and inflammation, cardiovascular events and deaths in Chinese hemodialysis patients bearing a radio-cephalic fistula (AVF) from 2009 to 2015. Twenty-three patients (35.9%) developed at least one episode of cardiovascular disease (CVD) in two years after AVF creation. AVF Qa, IL-6 and hsCRP were significantly higher in patients with CVD than in patients without CVD. Multi-factorial binary logistic regression analysis found that the independent and strongest risk factor for CVD in HD patients was serum IL-6, which showed a positive association with AVF Qa levels in patients. Therefore, the linkage between AVF Qa tertiles and adverse clinical outcomes (cardiovascular events and mortality) was examined over a median follow-up of five years. IL-6 was significantly increased in the high AVF Qa (>1027.13 ml/min) group. Patients with median AVF Qa showed the lowest morbidity and mortality of CVD according to the AVF Qa tertiles, whereas higher Qa was associated with a higher risk of CVD, and lower AVF Qa (600 ml/min ≤AVF Qa <821.12 ml/min) had a higher risk of non-CVD death. Therefore, keeping the AVF Qa at an optimal level (821.12 to 1027.13 ml/min) would benefit HD patients, improve long-term clinical outcomes and lower AVF-induced inflammation.