Effect of change in vascular access on patient mortality in hemodialysis patients
Effect of change in vascular access on patient mortality in hemodialysis patients
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DOI：
10.1053/j.ajkd.2005.11.023
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发表时间：
2006-03-01
影响因子：
13.2
通讯作者：
Schwab, SJ
中科院分区：
文献类型：
--
作者：
Allon, M;Daugirdas, J;Schwab, SJ
背景使用导管的血液透析患者比使用动静脉（AV）通路（瘘或移植物）的患者有更大的死亡风险。然而，导管依赖患者在几个临床特征上也不同于AV入路患者，这些差异本身可能导致其死亡率过高。方法：目前的研究评价血管通路的改变是否会影响血液透析研究患者的死亡风险。使用时间依赖性考克斯回归将死亡风险与当前的通路类型和前1年通路类型的变化联系起来。结果如下：与在前1年间隔开始和结束时均使用AV通路进行透析的患者相比，死亡率的相对风险为3.43（95%置信区间[CI]，2.42 - 4.86）; 2.38（95% CI，1.76 - 3.23），从AV入路转换为导管; 1.37（95% CI，0.81 - 2.32），从导管转换为AV入路。从AV入路到导管的改变与血清白蛋白水平（比值比，1.25; 95%CI，1.09 - 1.45/0.5 g/dL; P=0.002）、体重减轻（比值比，1.14; 95%CI，1.06 - 1.22/2 kg; P = 0.002）、
Background Hemodialysis patients using a catheter have a greater mortality risk than those using an arteriovenous (AV) access (fistula or graft). However, catheter-dependent patients also differ from those with an AV access in several clinical features, and these differences may themselves contribute to their excess mortality. Methods: The current study evaluates whether a change in vascular access affects risk for mortality in patients enrolled in the Hemodialysis Study. Time-dependent Cox regression was used to relate mortality risk to current type of access and change In access type during the preceding 1 year. Results: Compared with patients who dialyzed using an AV access at both the beginning and end of the preceding 1-year interval, relative risks for mortality were 3.43 (95% confidence interval [CI], 2.42 to 4.86) in patients who dialyzed with a catheter at both times; 2.38 (95% CI, 1.76 to 3.23) in patients switching from an AV access to a catheter, and 1.37 (95% CI, 0.81 to 2.32) in patients switching from a catheter to an AV access. Change from AV access to a catheter was associated with an antecedent decrease in serum albumin level (odds ratio, 1.25; 95% CI, 1.09 to 1.45 per 0.5 g/dL; P=0.002), weight loss (odds ratio, 1.14; 95% CI, 1.06 to 1.22 per 2 kg; P