Risk Factors for Primary Arteriovenous Fistula Dysfunction in Hemodialysis Patients: A Retrospective Survival Analysis in Multiple Medical Centers
Risk Factors for Primary Arteriovenous Fistula Dysfunction in Hemodialysis Patients: A Retrospective Survival Analysis in Multiple Medical Centers
复制标题
血液透析患者原发性动静脉瘘功能障碍的危险因素：多个医疗中心的回顾性生存分析
DOI：
10.1159/000500045
复制
发表时间：
2019-10-01
影响因子：
3
通讯作者：
Chen, Guochun
中科院分区：
文献类型：
--
作者：
Wen, Maowan;Li, Zheng;Chen, Guochun
背景：动静脉瘘（AVF）是血液透析（HD）的首选血管通路。然而，原发性 AVF 功能障碍是 HD 治疗长期成功的主要障碍。本研究旨在分析影响 HD 患者首次 AVF 失败发生率的变量。方法：2012年1月至2016年10月，来自43个医疗中心的总共100名HD受试者入组，进行AVF功能障碍的回顾性生存分析。为了减少外科医生经验的潜在影响，湘雅二医院的同一手术组实施了所有研究的 AVF 放置。本研究重点关注中国特发性肾小球疾病人群，以避免其他全身性疾病（包括糖尿病、高血压和自身免疫性疾病）的继发影响。 AVF功能障碍定义为透析期间血流量降低（≤200 mL/min）或因血流量减少导致HD治疗不足。结果：在所有入组受试者中，由于不通气导致 AVF 功能障碍的发生率为 27% (n = 27)，放置后 6、12 和 24 个月的累积生存率分别为 84.0、73.1 和 71.6%。 AVF 生存分析显示，女性 (p = 0.025) 和老年 (p = 0.031) 患者 AVF 失败的发生率较高。重要的是，在血小板水平较高（PLT；p = 0.024）、严重贫血（p = 0.014）和导管临时保留时间延长（p = 0.020）的受试者中，AVF 功能障碍显着增加。进一步的多变量 Cox 回归分析证实这些变量是首次 AVF 功能障碍的独立危险因素。同时，体重指数、血清白蛋白、血钙、血磷、凝血酶原时间、活化部分凝血活酶时间水平无显着性差异。最后，在本研究中，抗凝治疗似乎几乎不影响 AVF 的生存结果。结论：这些结果表明HD患者原发性AVF功能障碍与性别、年龄、PLT计数、血红蛋白水平和临时导管保留时间有关。
Background: Arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis (HD). However, primary AVF dysfunction represents a major barrier to the long-term success of HD therapy. This study aims to analyze the variables that influence the incidence of first AVF failure in HD patients. Methods: From January 2012 to October 2016, a total of 100 HD subjects from 43 medical centers were enrolled for a retrospective survival analysis of AVF dysfunction. To diminish the potential influence of surgeon experiences, the same operation group in Second Xiangya Hospital performed all studied AVF placements. This study focuses on a Chinese population of idiopathic glomerular disease to avoid the secondary influence of other systemic diseases, including diabetes, hypertension, and autoimmune disorder. AVF dysfunction was defined as lower blood flow during dialysis (≤200 mL/min) or insufficiency of HD treatment caused by reduced blood flow. Results: Among all enrolled subjects, the incidence of AVF dysfunction due to impatency was 27% (n = 27) with a cumulative survival of 84.0, 73.1, and 71.6% in 6, 12, and 24 months of post-placement. AVF survival analysis revealed a higher incidence of AVF failure in females (p= 0.025) and elderly (p = 0.031) patients. Importantly, AVF dysfunction markedly increased in subjects with higher levels of platelets (PLTs; p = 0.024), severe anemia (p = 0.014), and extended temporary catheter retention (p = 0.020). Further multivariate Cox regression analysis confirmed these variables as independent risk factors for first AVF dysfunction. Meanwhile, no significant difference could be observed according to the levels of body mass index, serum albumin, serum calcium, serum phosphorus, prothrombin time, and activated partial thromboplastin time. Lastly, anti-coagulant treatments seemed to barely influence the outcomes of AVF survival in this study. Conclusion: These findings suggest that primary AVF dysfunction in HD patients is associated with gender, ageing, PLT counting number, hemoglobin level, and retention time of temporary catheter.