Long-term effects of daily hemodialysis on vascular access outcomes: a prospective controlled study.
Long-term effects of daily hemodialysis on vascular access outcomes: a prospective controlled study.
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每日血液透析对血管通路结果的长期影响：一项前瞻性对照研究。
DOI：
10.1111/j.1542-4758.2012.00756.x
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Ayus,JuanCarlos
中科院分区：
文献类型：
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作者：
Achinger,StevenG;Ikizler,TAlp;Bian,Aihua;Shintani,Ayumi;Ayus,JuanCarlos
每日血液透析与血液透析患者生存率改善的替代标志物相关。每日血液透析的一个潜在缺点是频繁的血管通路插管可能会影响长期血管通路的通畅。该研究设计是一项为期 4 年、非随机、当代对照、前瞻性研究，对 77 名受试者进行每日 3 小时血液透析（每周 6 次 3 小时透析治疗；n = 26）或传统透析（每周 3 次 4 小时透析治疗；n = 51）的受试者进行研究。感兴趣的结果是血管通路手术（瘘管造影、血栓切除术和通路修正）。常规透析组的总通路手术（瘘管造影、血栓切除术和通路翻修）为每 1000 人年 543.2 例（95% 置信区间 [CI]：432.9, 673.0），而每日血液透析组为每 1000 人年 400.8 例（95% CI：270.2, 572.4） （发生率比 = 0.74，95% CI：0.40至1.36，P = 0.33），调整年龄、性别、糖尿病状况、血磷、血红蛋白水平和促红细胞生成素剂量后，总通路手术的发生率无显着差异（P值 > 0.05）。调整协变量后，每日透析组和常规透析组的首次访问修正时间没有差异（风险比 = 0.99 95% CI：0.42、2.36，P = 0.96）。每日血液透析与血管通路并发症的增加或血管通路失败率的增加无关。
Daily hemodialysis has been associated with surrogate markers of improved survival among hemodialysis patients. A potential disadvantage of daily hemodialysis is that frequent vascular access cannulations may affect long‐term vascular access patency. The study design was a 4‐year, nonrandomized, contemporary control, prospective study of 77 subjects in either 3‐h daily hemodialysis (six 3‐h dialysis treatments weekly; n = 26) or conventional dialysis (three 4‐h dialysis treatments weekly; n = 51). Outcomes of interest were vascular access procedures (fistulagram, thrombectomy and access revision). Total access procedures (fistulagram, thrombectomy and access revision) were 543.2 (95% confidence interval [CI]: 432.9, 673.0) per 1000 person‐years in the conventional dialysis group vs. 400.8 (95% CI: 270.2, 572.4) per 1000 person‐years in the daily hemodialysis dialysis group (incidence rate ratio = 0.74 with 95% CI: from 0.40 to 1.36, P = 0.33), after adjusting for age, gender, diabetes status, serum phosphorus, hemoglobin level and erythropoietin dose, there was no significant differences in incidence rate of total access procedures (P‐value > 0.05). There was no difference in time to first access revision between the daily dialysis and the conventional dialysis groups after adjustment for covariates (hazard ratio = 0.99 95% CI: 0.42, 2.36, P = 0.96). Daily hemodialysis is not associated with increased vascular access complications, or increased vascular access failure rates.