Salahi H, Fazelzadeh A, Mehdizadeh A, Razmkon A, Malek-Hosseini S-A
Southern Iran Organ Transplant Center, Fars, Iran.
Transplant Proc. 2006 Jun;38(5):1261-4. doi: 10.1016/j.transproceed.2006.02.066.
Repeated access to the circulation is essential to perform adequate maintenance hemodialysis (HD). Dysfunction of fistulae is the most common reason for a second intervention and recurrent hospitalization. The aim of this study was to evaluate the complications of HD fistulas seeking to evaluate the impact of age, site of arteriovenous fistula (AVF) (proximal or distal), side (left or right), and history of previous vascular access. We evaluated the clinical complications in 273 patients from the beginning of the use of the current access using the history and physical examination obtained at every dialysis session. We performed further investigations including doppler ultrasound or spiral computed tomography to confirm the clinical diagnosis. Of our patients, 40% had diabetes mellitus as the cause of end-stage renal disease. Almost half (49%) the patients dialyzed through an AVF and 13% with a catheter. One hundred eighty-four cases (67.6%) experienced complications. Of 145 cases that had elbow AVFs, 103 cases (71%) had complications; of 128 cases with wrist AVFs, 80 cases (62.5%) had complications. There were 115 (62.5%) complicated cases among 185 patients with left AVFs, and 69 (78%) among 88 patients with right AVFs. The rate of AVF complications increased with age. The 1-year survival rate was 94%. We did not observe any significant difference between AVF complications in patients with diabetes mellitus or hypertension as the underlying cause of renal failure. Mean cholesterol plasma level did not differ significantly between the patients with and without AVF complications. Mean hematocrit levels were not significantly different between the two groups. However, mean EPO weekly dose was significantly higher among the group of patients with AVF complications. We did find that rate of complications increased with age (P<.05). Our results showed that the frequency of complications was higher among patients with elbow and right-side AVFs, and also among patients with a history of a previous failed shunt but no significant relationship was observed between these variables (P>.05).
反复进行循环通路穿刺对于充分进行维持性血液透析（HD）至关重要。动静脉内瘘功能障碍是二次干预和再次住院的最常见原因。本研究的目的是评估血液透析动静脉内瘘的并发症，旨在评估年龄、动静脉内瘘（AVF）部位（近端或远端）、侧别（左侧或右侧）以及既往血管通路史的影响。我们从每次透析时获取的病史和体格检查开始，评估了273例患者在使用当前血管通路期间的临床并发症。我们进行了包括多普勒超声或螺旋计算机断层扫描在内的进一步检查以确诊临床诊断。我们的患者中，40%因糖尿病导致终末期肾病。近一半（49%）的患者通过动静脉内瘘进行透析，13%的患者使用导管。184例（67.6%）出现并发症。在145例肘部动静脉内瘘患者中，103例（71%）出现并发症；在128例腕部动静脉内瘘患者中，80例（62.5%）出现并发症。185例左侧动静脉内瘘患者中有115例（62.5%）出现并发症，88例右侧动静脉内瘘患者中有69例（78%）出现并发症。动静脉内瘘并发症的发生率随年龄增长而增加。1年生存率为94%。我们未观察到以糖尿病或高血压作为肾衰竭潜在病因的患者在动静脉内瘘并发症方面存在任何显著差异。有动静脉内瘘并发症和无并发症的患者之间平均血浆胆固醇水平无显著差异。两组之间平均血细胞比容水平无显著差异。然而，有动静脉内瘘并发症的患者组中平均每周促红细胞生成素剂量显著更高。我们确实发现并发症发生率随年龄增长而增加（P<0.05）。我们的结果表明，肘部和右侧动静脉内瘘患者以及既往分流失败史患者的并发症发生率更高，但未观察到这些变量之间存在显著相关性（P>0.05）。
