The Survival Benefit of "Fistula First, Catheter Last" in Hemodialysis Is Primarily Due to Patient Factors
The Survival Benefit of "Fistula First, Catheter Last" in Hemodialysis Is Primarily Due to Patient Factors
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DOI：
10.1681/asn.2016010019
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发表时间：
2017-02-01
影响因子：
13.6
通讯作者：
Goldfarb-Rumyantzev, Alexander S.
中科院分区：
文献类型：
--
作者：
Brown, Robert S.;Patibandla, Bhanu K.;Goldfarb-Rumyantzev, Alexander S.
需要血液透析的患者建议使用动静脉瘘而不是导管，因为死亡率明显较低。然而，瘘管置入的差异提高了患者因素在这种明显的死亡率获益中发挥作用的可能性。我们从美国肾脏数据系统（US Renal Data System）中提取了115,425名67岁的突发血液透析患者，并与医疗保险索赔相关联，以确定透析前血管通路。我们比较了先放置瘘管、先放置瘘管失败后再放置导管或先放置导管进行血液透析的患者的死亡率（n=90,517；参照组）。在21436例首先放置瘘管的患者中，9794例患者使用该瘘管开始血液透析，8230例患者在瘘管放置失败后使用导管开始透析。瘘管组在58个月内死亡率最低(风险比0.50；95%可信区间0.48 ~ 0.52；P
Patients needing hemodialysis are advised to have arteriovenous fistulas rather than catheters because of significantly lower mortality rates. However, disparities in fistula placement raise the possibility that patient factors have a role in this apparent mortality benefit. We derived a cohort of 115,425 patients on incident hemodialysis >= 67 years old from the US Renal Data System with linked Medicare claims to identify the first predialysis vascular access placed. We compared mortality outcomes in patients initiating hemodialysis with a fistula placed first, a catheter after a fistula placed first failed, or a catheter placed first (n=90,517; reference group). Of 21,436 patients with a fistula placed first, 9794 initiated hemodialysis with that fistula, and 8230 initiated dialysis with a catheter after failed fistula placement. The fistula group had the lowest mortality over 58 months (hazard ratio, 0.50; 95% confidence interval, 0.48 to 0.52; P