Patient Frailty and Functional Use of Hemodialysis Vascular Access: A Retrospective Study of the US Renal Data System.
Patient Frailty and Functional Use of Hemodialysis Vascular Access: A Retrospective Study of the US Renal Data System.
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血液透析血管通路的患者脆弱性和功能性应用：美国肾脏数据系统的一项回顾研究。
DOI：
10.1053/j.ajkd.2021.10.011
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发表时间：
2022-07
期刊：
影响因子：
--
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中科院分区：
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--
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尽管虚弱在透析患者中的患病率很高，但尚不清楚虚弱是否与透析血管通路失败有关。本研究探讨了虚弱和血管通路功能使用之间的关系。回顾性观察性研究。2012年至2017年在美国肾脏数据系统数据库中通过隧道导管进行血液透析，随后进行动静脉瘘或移植物创建的患者。“基于索赔的虚弱指标”（CFI）是使用一个有效的基于索赔的残疾状态模型来计算的，该模型锚定在一个描述良好的虚弱表型上。对瘘管和移植物的功能性使用时间定义为从开始血液透析到使用2针的指数血管通路进行治疗的时间。Fine和Gray竞争风险模型分别检查瘘管和移植物的结果。采用Cox比例风险回归对整个队列的患者生存进行建模。共有41471例患者符合纳入标准，其中33212例接受了造瘘术，8259例接受了移植物植入。较高的CFI四分位数与较高的死亡率相关。CFI最高四分位数患者的死亡率是CFI最低四分位数患者的2倍以上（风险比[HR]， 2.49 [95% CI, 2.41-2.58]）。在多变量分析中，最高的CFI四分位数与更长的功能性使用时间（HR, 0.65 [95% CI, 0.62-0.69]）和移植物（HR, 0.88 [95% CI, 0.79-0.98]）显著相关。可通用性可能受到限制，要求12个月的医疗保险索赔开始透析前的可用性。没有关于患者解剖特征或外科医生特征的数据，以及有限的患者特定的社会人口学数据。较高程度的虚弱与较长的血管通道功能使用时间有关。虚弱可能是有用的通知临床决策有关选择血管通路。
Despite the high prevalence of frailty among dialysis patients, it is unknown whether frailty is associated with dialysis vascular access failure. This study examined the association between frailty and functional use of vascular access. Retrospective observational study. Patients who initiated hemodialysis through a tunneled catheter in the US Renal Data System database from 2012 through 2017 and underwent subsequent creation of an arteriovenous fistula or graft. The “claims-based frailty indicator” (CFI) was calculated using a validated claims-based disability status model anchored to a well-described frailty phenotype. Time to functional use for fistulas and grafts defined as the time from initiation of hemodialysis to treatments using the index vascular access with 2 needles. Fine and Gray competing risk models separately examining fistula and graft outcomes. Patient survival was modeled for the entire cohort using Cox proportional hazards regression. A total of 41,471 patients met inclusion criteria, including 33,212 who underwent fistula creation and 8,259 who underwent graft placement. Higher CFI quartiles were associated with a greater rate of mortality. Patients in the highest CFI quartile had more than 2 times the rate of mortality compared with patients in the lowest CFI quartile (hazard ratio [HR], 2.49 [95% CI, 2.41–2.58]). In multivariable analyses, the highest CFI quartile was significantly associated with longer time to functional use of fistulas (HR, 0.65 [95% CI, 0.62–0.69]) and grafts (HR, 0.88 [95% CI, 0.79–0.98]). Generalizability may be limited by the requirement of 12 months of Medicare claims availability before initiation of dialysis. There were no data on patient anatomic characteristics or surgeon characteristics and limited patient-specific sociodemographic data. Higher degrees of frailty are associated with longer times to vascular access functional use. Frailty may be useful for informing clinical decision-making regarding choice of vascular access.
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影响因子：
2
作者：
Drost D;Kalf A;Vogtlander N;van Munster BC
通讯作者：
van Munster BC
影响因子：
1.5
作者：
Houghton, John S. M.;Nickinson, Andrew T. O.;Sayers, Rob
通讯作者：
Sayers, Rob
影响因子：
3
作者：
Segal JB;Chang H-Y;Du Y;Walston JD;Carlson MC;Varadhan R
通讯作者：
Varadhan R
DOI：
10.2215/cjn.02190216
发表时间：
2016-08-01
影响因子：
9.8
作者：
Woo, Karen;Lok, Charmaine E.
通讯作者：
Lok, Charmaine E.
影响因子：
4.1
作者：
Theriault, Brianna C.;Pazniokas, Julia;Bowers, Christian A.
通讯作者：
Bowers, Christian A.