Astor B C, Coresh J, Powe N R, Eustace J A, Klag M J
Departments of Epidemiology, Biostatistics, and Health Policy and Management, The Johns Hopkins School of Hygiene and Public Health, Baltimore, MD, USA.
Am J Kidney Dis. 2000 Dec;36(6):1126-34. doi: 10.1053/ajkd.2000.19816.
Native arteriovenous (AV) fistulae for hemodialysis vascular access are believed to be associated with fewer complications than synthetic polytetrafluoroethylene (PTFE) grafts. We conducted a study among patients in the Dialysis Morbidity and Mortality Study to compare risk factors for complications of AV fistulae and PTFE grafts in men and women and to examine the effect of age on vascular access complications. We analyzed data from 833 incident patients with end-stage renal disease who had a PTFE graft (n = 621) or AV fistula (n = 212) in use 1 month after starting hemodialysis therapy. Follow-up using inpatient and outpatient Medicare administrative data identified a 1.8-times greater risk for a subsequent vascular access procedure for PTFE grafts (0.71 procedures/access-year) than for AV fistulae (0.39 procedures/access-year). Men with grafts and women with grafts or fistulae had a greater risk for a first subsequent access procedure than did men with fistulae (0.79, 0.65, and 0.59 versus 0.33 procedures/access-year, respectively). After adjustment for age, race, presence of diabetes mellitus, and history of smoking, peripheral vascular disease, and cardiovascular disease, use of a PTFE graft compared with an AV fistula was associated with a greater risk for a first subsequent procedure in men (relative hazard, 2.2; 95% confidence interval [CI], 1.6 to 2.9), but not in women (relative hazard, 1.0; 95% CI, 0.7 to 1.4). The excess risk associated with a PTFE graft compared with an AV fistula was limited to men in the lower three quartiles of age (ie, </=72 years). These data raise concern that the potential benefits of AV fistulae over PTFE grafts are not realized in women and older men. A better understanding of the determinants of successful access maturation and maintenance in these groups is needed.
人们认为，用于血液透析血管通路的自体动静脉（AV）内瘘比合成聚四氟乙烯（PTFE）移植物引发的并发症更少。我们在透析发病率和死亡率研究的患者中开展了一项研究，以比较男性和女性AV内瘘与PTFE移植物并发症的危险因素，并研究年龄对血管通路并发症的影响。我们分析了833例终末期肾病初发患者的数据，这些患者在开始血液透析治疗1个月后使用了PTFE移植物（n = 621）或AV内瘘（n = 212）。利用住院和门诊医疗保险管理数据进行随访发现，PTFE移植物后续进行血管通路手术的风险（0.71次手术/通路年）是AV内瘘（0.39次手术/通路年）的1.8倍。接受移植物的男性以及接受移植物或内瘘的女性首次进行后续通路手术的风险高于接受内瘘的男性（分别为0.79、0.65和0.59次手术/通路年，而接受内瘘的男性为0.33次手术/通路年）。在对年龄、种族、糖尿病的存在以及吸烟史、外周血管疾病和心血管疾病进行调整后，与AV内瘘相比，使用PTFE移植物的男性首次进行后续手术的风险更高（相对风险，2.2；95%置信区间[CI]，1.6至2.9），但女性并非如此（相对风险，1.0；95%CI，0.7至1.4）。与AV内瘘相比，PTFE移植物相关的额外风险仅限于年龄处于较低三个四分位数的男性（即≤72岁）。这些数据令人担忧，即AV内瘘相对于PTFE移植物的潜在益处并未在女性和老年男性中体现出来。需要更好地了解这些人群成功实现通路成熟和维持的决定因素。
