Cardiovascular comorbidity and late referral impact arteriovenous fistula survival: A prospective multicenter study
Cardiovascular comorbidity and late referral impact arteriovenous fistula survival: A prospective multicenter study
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DOI：
10.1097/01.asn.0000103870.31606.90
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发表时间：
2004-01-01
影响因子：
13.6
通讯作者：
Malberti, F
中科院分区：
文献类型：
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作者：
Ravani, P;Brunori, G;Malberti, F
自体动静脉内瘘（AVF）在血液透析血管通路中具有最佳的5年通畅率和最低的并发症发生率。然而，优化生存的成熟要求是未知的。进行了一项纵向队列研究，以确定第一个AVF失败、成熟时间和生存的风险因素。本研究纳入了1997年1月1日至2002年12月31日期间在三个中心开始血液透析的所有患者。分析仅限于接受AVE的患者，使用考克斯回归估计关注的预测因子与原发性和继发性AVF生存率之间的相关性。在入组的535例患者中（平均年龄：66.5岁; 57.8%为男性; 26.7%为糖尿病患者），513例（96%）接受了AVE，这些患者开始使用导管（47%），较早插入AVF（中位成熟期：0.78 vs 1.80个月; P < 0.001）。中位一期和二期生存期分别超过50和72个月。调整混杂因素后，心血管疾病（风险比[HR]，1.84; 95%置信区间[CI]，1.26 - 2.67），放置后1个月内使用（HR，1.94; 95% CI，1.34 - 2.82）和透析开始后3个月内转诊（HR，1.55; 95% CI，1.04 - 2.32）与原发性AVF生存率降低相关。存在心血管疾病（HR，2.21; 95% CI，1.38 - 3.55），成熟时间
Autologous arteriovenous fistulas (AVF) have the best 5-yr patency and the lowest complication rate among hemodialysis vascular accesses. However, maturation requirements to optimize survival are unknown. A longitudinal cohort study was conducted to ascertain risk factors for failure, maturation time, and survival of the first AVF. All patients who initiated hemodialysis between January 1, 1997, and December 31, 2002, in three centers were included in this study. Analysis was restricted to patients who received an AVE Cox regression was used to estimate the association between predictors of interest and primary and secondary AVF survival. Of the 535 patients enrolled (mean age, 66.5 yr; 57.8% male; 26.7% diabetic), 513 (96%) received an AVE Patients who initiated with catheters (47%) cannulated their AVF earlier (median maturation period, 0.78 versus 1.80 mo; P < 0.001). Median primary and secondary survivals were longer than 50 and 72 mo, respectively. After adjustment for confounding factors, cardiovascular disease (hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.26 to 2.67), utilization earlier than I mo after placement (HR, 1.94; 95% CI, 1.34 to 2.82), and referral within 3 mo of dialysis start (HR, 1.55; 95% CI, 1.04 to 2.32) were associated with a reduction in primary AVF survival. Presence of cardiovascular disease (HR, 2.21; 95% CI, 1.38 to 3.55), maturation time