Type of vascular access and mortality in US hemodialysis patients
Type of vascular access and mortality in US hemodialysis patients
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DOI：
10.1046/j.1523-1755.2001.00947.x
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发表时间：
2001-10-01
影响因子：
19.6
通讯作者：
Port, FK
中科院分区：
文献类型：
--
作者：
Dhingra, RK;Young, EW;Port, FK
背景血管通路（VA）并发症占住院人数的16%至25%。本研究验证了使用VA的类型与总死亡率和病因特异性死亡率相关的假设。数据分析来自美国肾脏数据系统透析发病率和死亡率研究第1波，随机抽样5507例患者，截至1993年12月31日，普遍接受血液透析。在两年的观察期内，通过Cox回归方法对相对死亡风险进行分析，并对人口统计学和共病情况进行调整。采用类似的方法，对感染和心脏原因引起的死亡进行了原因特异性分析。在糖尿病（DM）终末期肾病患者中，动静脉移植物（AVG; RR = 1.41，P < 0.003）和中心静脉移植物的相关相对死亡风险较高。CVC（RR = 1.54，P < 0.002）与动静脉内瘘（AVF）比较。在非DM患者中，CVC患者的相关死亡率较高（RR = 1.70。P < 0.001），AVG患者的情况也较轻（RR = 1.08，P = 0.35）与AVE相比，原因特异性分析发现CVC的感染相关死亡率较高糖尿病组中，与AVF相比，CVC（RR = 2.30，P < 0.06）和AVG（RR = 2.47，P < 0.02）的风险更高;非糖尿病组中，CVC（RR = 1.83，P < 0.04）和AVG（RR = 1.27，P <0.05）的风险也更高。P < 0.33）。与房室分流增加心脏风险的假设相反，糖尿病和非糖尿病患者中，CVC的心脏原因死亡率均高于AVF（RR = 1.47，P < 0.05）。该病例组合调整分析表明，与AVF相比，CVC和AVG与死亡风险增加相关，无论是总体死亡还是主要死亡原因。
Background. Vascular access (VA) complications account for 16 to 25% of hospital admissions. This study tested the hypothesis that the type of VA in use is correlated with overall mortality and cause-specific mortality.Methods. Data were analyzed from the U.S. Renal Data System Dialysis Morbidity and Mortality Study Wave 1, a random sample of 5507 patients, prevalent on hemodialysis as of December 31, 1993. The relative mortality risk during a two-year observation was analyzed by Cox-regression methods with adjustments for demographic and comorbid conditions. Using similar methods, cause-specific analyses also were performed for death caused by infection and cardiac causes.Results. In diabetic mellitus (DM) patients with end-stage renal disease, the associated relative mortality risk was higher for those with arteriovenous graft (AVG; RR = 1.41, P < 0.003) and central venous. catheter (CVC; RR = 1.54, P < 0.002) as compared with arteriovenous fistula (AVF). In non-DM patients, those with CVC had a higher associated mortality (RR = 1.70. P < 0.001), as did to a lesser degree those with AVG (RR = 1.08, P = 0.35) when compared with AVE Cause-specific analyses found higher infection-related deaths for CVC (RR = 2.30, P < 0.06) and AVG (RR = 2.47, P < 0.02) compared with AVF in DM; in non-DM, risk was higher also for CVC (RR = 1.83, P < 0.04) and AVG (RR = 1.27. P < 0.33). In contrast to our hypothesis that AV shunting increases cardiac risk, deaths caused by cardiac causes were higher in CVC than AVF for both DM (RR = 1.47, P < 0.05) and nonDM (RR = 1.34, P < 0.05) patients.Conclusion. This case-mix adjusted analysis suggests that CVC and AVG are correlated with increased mortality risk when compared with AVF, both overall and by major causes of death.