Vascular access type and risk of mortality in a national prospective cohort of haemodialysis patients
Vascular access type and risk of mortality in a national prospective cohort of haemodialysis patients
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DOI：
10.1093/qjmed/hcs143
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发表时间：
2012-11-01
影响因子：
13.3
通讯作者：
Metcalfe, W.
中科院分区：
文献类型：
--
作者：
Bray, B. D.;Boyd, J.;Metcalfe, W.
背景资料：中心静脉导管（CVC）是菌血症的潜在来源，与血液透析患者的死亡率增加相关。我们的目的是调查血液透析血管通路之间的关系，考虑到血管通路类型的变化，在患者的生活中，并导致特定的死亡风险在全国队列的dialysis patients.Methods：前瞻性队列研究，包括所有患者接受血液透析在苏格兰年度横断面调查在2009年，2010年和2011年。通过苏格兰肾脏登记处和死亡后病例记录的结构化审查收集数据。考克斯比例风险回归和多变量logistic回归模型分别用于生存和死亡的败血症risk.Results：一个队列的2666例患者，873（32%）在随访期间死亡。在病例组合调整后，在既往肾脏替代治疗暴露的所有分层中，随访期间仅使用隧道CVC的患者的全因死亡风险较高[调整的风险比（HR）：1.83-2.08]。在该组中，病例组合调整的心血管死亡（调整的HR：2.20-2.95）和感染相关死亡（调整的HR：3.10-3.63）风险也较高。在随访期间和死亡前使用隧道CVC的患者死于败血症的几率比仅使用动静脉瘘或移植物的患者高6.9倍。结论：与动静脉瘘或移植物相比，持续使用隧道CVC进行血管通路与全因、心血管和感染相关死亡率的较高风险相关。
Background: Central venous catheters (CVC) are a potential source of bacteraemia and have been associated with increased mortality in haemodialysis patients. We aimed to investigate the relationships between haemodialysis vascular access, taking into account changes in vascular access type during patients' lives, and cause specific mortality risk in a national cohort of dialysis patients.Methods: Prospective cohort study including all patients receiving haemodialysis in Scotland at annual cross sectional surveys in 2009, 2010 and 2011. Data were collected through the Scottish Renal Registry and by a structured review of case records following death. Cox proportional hazards regression and multivariable logistic regression were used to model survival and risk of death from septicaemia respectively.Results: Of a cohort of 2666 patients, 873 (32%) died during follow-up. After case-mix adjustment, patients using only tunnelled CVC during follow-up had a higher risk of all cause mortality across all strata of prior renal replacement therapy exposure [adjusted hazard ratio (HR): 1.83-2.08]. Case-mix adjusted risks of cardiovascular death (adjusted HR: 2.20-2.95) and infection-related death (adjusted HR: 3.10-3.63) were also higher in this group. Patients using tunnelled CVCs during follow-up and prior to death had 6.9-fold higher odds of death from septicaemia compared with those using only arteriovenous fistulae or grafts.Conclusions: Compared with an arteriovenous fistula or graft, sustained use of tunnelled CVCs for vascular access is associated with higher risks of all-cause, cardiovascular and infection-related mortality.