Long-Term Outcomes of Arteriovenous Fistulas with Unassisted versus Assisted Maturation: A Retrospective National Hemodialysis Cohort Study
Long-Term Outcomes of Arteriovenous Fistulas with Unassisted versus Assisted Maturation: A Retrospective National Hemodialysis Cohort Study
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DOI：
10.1681/asn.2019030318
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发表时间：
2019-11-01
影响因子：
13.6
通讯作者：
Allon, Michael
中科院分区：
文献类型：
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作者：
Lee, Timmy;Qian, Joyce Zhang;Allon, Michael
背景：大约一半的动静脉瘘（avf）在成功使用透析前需要一次或多次干预，这一过程称为辅助成熟。先前的研究表明，辅助成熟与非辅助成熟相比，在成熟后放弃AVF和干预维持通畅的情况可能更常见。方法使用美国肾脏数据系统，我们回顾性比较了辅助和非辅助AVF成熟患者的成熟后AVF结局，包括功能性原发性通畅丧失（在AVF成熟后需要干预）、AVF放弃和干预频率。结果：我们纳入了7301例患者，年龄为bb0 = 67岁，于2010年7月至2012年6月期间开始血液透析，使用导管，既往无AVF；所有患者均在开始血液透析的6个月内产生AVF，并在6个月内用于透析（成熟），成熟后随访2年。56%的患者在没有事先干预的情况下avf成熟。分别有23%、12%、5%和4%的患者通过1次、2次、3次或4次或更多的过早成熟干预辅助AVF成熟。与未辅助的AVF成熟患者相比，接受过早成熟干预的患者功能性原发性通畅丧失的风险显著增加，并且随着干预次数的增加，风险增加。虽然与未辅助的AVF成熟患者相比，接受多达三次提前成熟干预的患者放弃AVF的可能性并不高，但接受四次或更多干预的患者放弃AVF的可能性明显更高。对于这组接受辅助AVF成熟的患者，我们观察到成熟前AVF干预的次数与功能性原发性通畅丧失的可能性和成熟后干预的频率呈正相关。
Background About half of arteriovenous fistulas (AVFs) require one or more interventions before successful dialysis use, a process called assisted maturation. Previous research suggested that AVF abandonment and interventions to maintain patency after maturation may be more frequent with assisted maturation versus unassisted maturation.Methods Using the US Renal Data System, we retrospectively compared patients with assisted versus unassisted AVF maturation for postmaturation AVF outcomes, including functional primary patency loss (requiring intervention after achieving AVF maturation), AVF abandonment, and frequency of interventions.Results We included 7301 patients >= 67 years who initiated hemodialysis from July 2010 to June 2012 with a catheter and no prior AVF; all had an AVF created within 6 months of starting hemodialysis and used for dialysis (matured) within 6 months of creation, with 2-year postmaturation follow-up. AVFs matured without prior intervention for 56% of the patients. Assisted AVF maturation with one, two, three, or four or more prematuration interventions occurred in 23%, 12%, 5%, and 4% of patients, respectively. Patients with prematuration interventions had significantly increased risk of functional primary patency loss compared with patients who had unassisted AVF maturation, and the risk increased with the number of interventions. Although the likelihood of AVF abandonment was not higher among patients with up to three prematuration interventions compared with patients with unassisted AVF maturation, it was significantly higher among those with four or more interventions.Conclusions For this cohort of patients undergoing assisted AVF maturation, we observed a positive association between the number of prematuration AVF interventions and the likelihood of functional primary patency loss and frequency of postmaturation interventions.