Vascular access outcomes in the elderly hemodialysis population: A USRDS study
Vascular access outcomes in the elderly hemodialysis population: A USRDS study
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DOI：
10.1111/j.1525-139x.2007.00370.x
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发表时间：
2007-11-01
影响因子：
1.6
通讯作者：
Yevzlin, Alexander S.
中科院分区：
文献类型：
--
作者：
Chan, Micah R.;Sanchez, Robert J.;Yevzlin, Alexander S.
动静脉内瘘（AVF）因其一期通畅性和患者生存获益而被广泛视为血液透析（HD）患者的首选血管通路。最近的学术研究表明，老年人群在炎症标志物方面与普通人群有显著差异。更重要的是，最近的研究表明，与年轻队列相比，老年HD人群不太可能将AVF作为初始血管通路。本研究的目的是调查当前血管通路指南对老年HD人群的适用性。我们假设老年HD人群从AVF置入中获得的通畅率和生存获益相对于动静脉移植物（AVG）要低于一般人群。我们使用美国肾脏数据系统（USRDS）Wave II数据集进行了一项回顾性分析，以探索介入或入路失败转诊的重要预测因素，并使用经种族、性别、外周血管疾病、糖尿病和营养状态校正的考克斯回归分析，在美国老年HD人群中探索患者生存率。在1471例AVF或AVG HD患者中，764例患者年龄> 65岁。与AVG相比，老年糖尿病患者使用AVF没有显著的死亡率获益[比值比（OR）1.34（95% CI 0.92-1.95），p = 0.123]。同样，与AVG相比，老年非糖尿病患者使用AVF没有显著的死亡率获益[OR 1.05（95% CI 0.81-1.36），p = 0.735]。老年糖尿病患者AVF与AVG的干预转诊比值无差异[OR 1.49（95% CI 0.76-2.9），p = 0.24]。老年非糖尿病患者AVF与AVG相比，介入转诊的比值没有差异[OR 1.48（95% CI 0.95-2.3），p = 0.08]。我们得出结论，AVF与AVG和中心静脉导管（CVC）相比的潜在受益可能并不普遍适用。对于老年患者，国家指南中规定的血管通路选择建议可能需要修改。
Arteriovenous fistulae (AVF) are widely regarded as the preferred vascular access in hemodialysis (HD) patients due to their primary patency and patient survival benefits. Recent scholarship has suggested that the elderly population differs significantly from the general population in terms of inflammatory markers. What is more, recent studies have suggested that the elderly HD population is less likely to have an AVF placed as the initial vascular access compared to a younger cohort. The purpose of this study is to investigate the applicability of current vascular access guidelines to the elderly HD population. We hypothesized that the elderly HD population would derive less patency and survival benefit from AVF placement relative to arteriovenous graft (AVG) than the general population is known to derive. We performed a retrospective analysis using the US Renal Data System (USRDS) Wave II dataset to explore significant predictors of referral for intervention or access failure, and patient survival in the elderly US HD population using Cox regression corrected for race, gender, peripheral vascular disease, diabetes mellitus, and nutritional status. Of the 1471 HD patients with AVF or AVG, 764 patients were > 65 years. Elderly diabetics had no significant mortality benefit from the use of AVF compared to AVG [odds ratio (OR) 1.34 (95% CI 0.92-1.95), p = 0.123]. Likewise, elderly nondiabetics had no significant mortality benefit from the use of AVF compared to AVG [OR 1.05 (95% CI 0.81-1.36), p = 0.735]. Elderly diabetics had no difference in odds for intervention referral for AVF compared to AVG [OR 1.49 (95% CI 0.76-2.9), p = 0.24]. Elderly nondiabetics had no difference in odds for intervention referral for AVF compared to AVG [OR 1.48 (95% CI 0.95-2.3), p = 0.08]. We conclude that the potential benefits derived from AVFs compared with AVGs and central venous catheters (CVC) may not apply universally. The recommendations of vascular access choice stipulated by national guidelines may need to be modified for elderly patients.