Hemodialysis vascular access survival: Upper-arm native arteriovenous fistula
Hemodialysis vascular access survival: Upper-arm native arteriovenous fistula
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DOI：
10.1053/ajkd.2002.29886
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发表时间：
2002-01-01
影响因子：
13.2
通讯作者：
Fangman, J
中科院分区：
文献类型：
--
作者：
Dixon, BS;Novak, L;Fangman, J
使用放射头前臂瘘(下臂瘘[LAF])的本土动静脉瘘获得透析结果质量倡议指南是困难的。这项研究报告了使用上臂自然动静脉瘘(UAF)的结果。根据预期访问数据库(1992-1998)，这项研究基于204名患者(322次访问)。患者的平均年龄为56+/-1岁，其中63%为男性，47%患有糖尿病。73%的患者(36%，LAFS；37%，UAFs)首次就诊时为自发性瘘管，占后续就诊的48%(13%，LAFS；35%，UAFs)。更年轻的男性更有可能接受LAF，但接受UAF或动静脉移植(AVG)的患者在统计学上没有差异。UAFs的初级无辅助通畅率和累积通畅率均明显好于LAF或AVG。对于首次访问，1、3和5年的累积访问通畅率分别为UAFs的71%、57%和57%；LAF的54%、46%和36%；AVG的54%、28%和0%(P<；0.01)。尽管接入存活期较短，但AVG需要比UAF或LAF更多的总接入程序(每次接入程序：AVG、UAFs和LAF分别为2.5、1.0和0.6)。使用导尿管时，UAFs的透析时间较长(中位导尿管天数，AVG、LAF和UAFs分别为36、53和56天；P<；0.05)。UAFs(1,247mL/min；n=48；P<；0.01)高于AVG(851mL/min；n=30)或LAF(938mL/min；n=31)。没有证据表明，与AVG或LAF相比，UAFs因盗窃综合征或心力衰竭而更频繁地被捆绑或结扎。这些结果表明，在实现透析结果质量倡议指南方面，UAF是AVG的良好替代品。(C)2002年，由国家肾脏基金会公司提供。
Achieving Dialysis Outcomes Quality Initiative guidelines for native arteriovenous fistulae using the radiocephalic forearm fistula (lower-arm fistula [LAF]) is difficult. This study reports results using the upper-arm native arteriovenous fistula (UAF). From a prospective access database (1992 to 1998), this study was based on 204 patients (322 accesses). Average patient age was 56 +/- 1 years, 63% were men, and 47% had diabetes. A native fistula was the first access in 73% of patients (36%, LAFs; 37%, UAFs) and accounted for 48% of subsequent accesses (13%, LAFs; 35%, UAFs). Younger men were more likely to receive an LAF, but there was no demographic difference between patients receiving a UAF or arteriovenous graft (AVG). Both primary unassisted and cumulative access patencies were significantly better for UAFs than either LAFs or AVGs. For first accesses, cumulative access patency rates at 1, 3, and 5 years were 71%, 57%, and 57% for UAFs; 54%, 46%, and 36% for LAFs; and 54%, 28%, and 0% for AVGs (P < 0.01). Despite shorter access survival, AVGs required more total access procedures than either UAFs or LAFs (procedures per access: 2.5, 1.0, and 0.6 for AVGs, UAFs, and LAFs, respectively). When used, catheters were required for dialysis for a longer time for UAFs (median catheter days, 36, 53, and 56 for AVGs, LAFs, and UAFs, respectively; P < 0.05). Access flow rates were greater in UAFs (1,247 mL/min; n = 48; P < 0.01) than AVGs (851 mL/min; n = 30) or LAFs (938 mL/min; n = 31). There was no evidence that UAFs were banded or ligated for steal syndromes or heart failure more often than AVGs or LAFs. These results show that the UAF Is a good alternative to an AVG for achieving Dialysis Outcomes Quality Initiative guidelines. (C) 2002 by the National Kidney Foundation, Inc.