Factors predicting failure of AV "fistula first" policy in the elderly
Factors predicting failure of AV "fistula first" policy in the elderly
复制标题
DOI：
10.1111/hdi.12106
复制
发表时间：
2014-04-01
影响因子：
1.3
通讯作者：
Goldfarb-Rumyantzev, Alexander S.
中科院分区：
文献类型：
--
作者：
Hod, Tammy;DeSilva, Ranil N.;Goldfarb-Rumyantzev, Alexander S.
动静脉瘘（AVF）是首选的血液透析（HD）途径。本研究的目的是确定老年HD人群透析前AVF衰竭的相关因素。我们使用美国肾脏数据系统+医疗保险索赔数据来识别b> = 67岁的患者，他们在透析前有AVF作为初始血管通道。AVF未能用于初始HD，作为结果。采用Logistic回归模型分析AVF失效的相关因素。研究队列包括20,360名受试者（76.2±6.02岁，58.5%为男性）。48%的患者使用AVF开始透析，而52%的患者使用导管或AVG。当AVF在hd开始前至少4个月产生时，发现以下变量与AVF衰竭相关：年龄较大（优势比[or] 1.01； 95%置信区间[CI] 1.55- 1.02），女性（or 1.69; 95% CI 1.55-1.83），黑人（or 1.41; 95% CI 1.26-1.58），糖尿病史（or 1.22; 95% CI 1.06-1.39），心力衰竭(or 1.26；95% CI 1.15-1.37)，终末期肾病（ESRD）前肾病护理的持续时间更短（ESRD前肾病护理少于6个月的OR为1.22，而ESRD前肾病随访超过12个月的OR为1.07-1.38）。AVF失败的OR在整个队列中显示了类似的结果。在老年HD人群中，年龄较大、女性、黑人、糖尿病、心力衰竭和较短的esrd前肾病治疗与透析前AVF衰竭有关。
An arteriovenous fistula (AVF) is the preferential hemodialysis (HD) access. The goal of this study was to identify factors associated with pre-dialysis AVF failure in an elderly HD population. We used United States Renal Data System + Medicare claims data to identify patients >= 67 years old who had an AVF as their initial vascular access placed pre-dialysis. Failure of the AVF to be used for initial HD, was used as the outcome. Logistic regression model was used to identify factors associated with AVF failure. The study cohort consisted of 20,360 subjects (76.2 +/- 6.02 year old, 58.5% men). Forty-eight percent of patients initiated dialysis using an AVF, while 52% used a catheter or an AVG. The following variables found to be associated with AVF failure when an AVF was created at least 4 months pre-HD initiation: older age (odds ratio [OR] 1.01; 95% confidence interval [CI] 1.00-1.02), female gender (OR 1.69; 95% CI 1.55-1.83), black race (OR 1.41; 95% CI 1.26-1.58), history of diabetes (OR 1.22; 95% CI 1.06-1.39), cardiac failure (OR 1.26; 95% CI 1.15-1.37), and shorter duration of pre-end-stage renal disease (ESRD) nephrology care (OR for a nephrology care of less than 6 months prior to ESRD of 1.22 compared with a pre-ESRD nephrology follow up of more than 12 months; 95% CI 1.07-1.38). OR for AVF failure for the entire cohort showed similar findings. In an elderly HD population, there is an association of older age, female gender, black race, diabetes, cardiac failure and shorter pre-ESRD nephrology care with predialysis AVF failure.