动静脉内瘘的初次通畅率及患者变量的影响。

Primary patency rates of AV fistulas and the effect of patient variables.

作者信息

Field M, MacNamara K, Bailey G, Jaipersad A, Morgan R H, Pherwani A D

机构信息

The Vascular Unit, University Hospital of North Staffordshire NHS Trust, UK.

出版信息

J Vasc Access. 2008 Jan-Mar;9(1):45-50.

PMID:18379980

Abstract

BACKGROUND

DOQI (The Dialysis Outcomes Quality Initiative) recommend 40% of prevalent renal failure patients should be undergoing hemodialysis (HD) using autogenous arteriovenous fistulae (AVF). The aim of this study is to assess the primary patency rates of wrist and elbow fistulae, and to examine how patient variables influence the success of a fistula. In addition, an attempt has been made to address the main issue of survival rates in this high risk patient population.

METHODS

A retrospective study was performed on all patients in the University Hospital of North Staffordshire who underwent creation of a wrist or elbow fistula for HD. During the study period 289 primary AVFs were created. In all, 210 AVF were sited at the wrist and 79 at the elbow. Follow-up ranged from 3 months to 4 yrs. Primary patency and patient death, transplant and transfer were taken as end points. Patient survival was defined as time of fistula creation to patient death. Actuarial survival was calculated using Kaplan-Meier survival analyses, with differences between groups determined using log rank analysis, and statistical significance obtained using X2 tests.

RESULTS

Primary patency for wrist fistulae was 49, 41 and 32% at 6, 12 and 24 months, respectively, and 57, 51 and 38% for elbow fistulae. Regression analysis showed fistula survival to be significantly greater in males than in females (p=0.023). Fistula survival rates in non-diabetics patients were higher than in patients with diabetes however, this was not significant (p=0.11); (54, 48 and 34% in diabetics compared to 45, 35 and 26% in non-diabetics at 6, 12 and 24 months, respectively). Age did not influence fistula survival; however, it did affect patient survival. Patient survival was 90, 74 and 56% at 1, 2 and 3 yrs, respectively, and in >60s fell to 86, 71 and 50%. Overall 74/245 (30%) patients died.

CONCLUSION

These results suggest that overall primary patency rates for wrist and elbow fistulae are comparable to similar studies at 6, 12 and 24 months. Fistula survival after this period is dictated by poor patient survival. Our findings suggest that creation of primary vascular access at the elbow in older females and diabetics may be associated with better results.

摘要

背景

美国肾脏病预后质量倡议（DOQI）建议，40%的晚期肾衰竭患者应使用自体动静脉内瘘（AVF）进行血液透析（HD）。本研究旨在评估腕部和肘部内瘘的初次通畅率，并探讨患者变量如何影响内瘘的成功。此外，还尝试解决这一高风险患者群体的生存率这一主要问题。

方法

对北斯塔福德郡大学医院所有因HD而进行腕部或肘部内瘘造瘘的患者进行回顾性研究。在研究期间，共创建了289个原发性AVF。其中，210个AVF位于腕部，79个位于肘部。随访时间为3个月至4年。将初次通畅情况以及患者死亡、移植和转院作为终点指标。患者生存率定义为从内瘘造瘘至患者死亡的时间。使用Kaplan-Meier生存分析计算精算生存率，使用对数秩分析确定组间差异，并使用X2检验获得统计学显著性。

结果

腕部内瘘在6、12和24个月时的初次通畅率分别为49%、41%和32%，肘部内瘘分别为57%、51%和38%。回归分析显示，男性内瘘生存率显著高于女性（p = 0.023）。非糖尿病患者的内瘘生存率高于糖尿病患者，然而，差异无统计学意义（p = 0.11）；（糖尿病患者在6、12和24个月时分别为54%、48%和34%，非糖尿病患者分别为45%、35%和26%）。年龄不影响内瘘生存率；然而，它确实影响患者生存率。患者在1、2和3年时的生存率分别为90%、74%和56%，60岁以上患者降至86%、71%和50%。总体而言，74/245（30%）的患者死亡。