Weber Catherine L, Djurdjev Ognjenka, Levin Adeera, Kiaii Mercedeh
Division of Nephrology, Department of Medicine, University British Columbia, Vancouver, British Columbia, Canada.
ASAIO J. 2009 Jul-Aug;55(4):355-60. doi: 10.1097/MAT.0b013e31819f635c.
A 2-year single institution experience of the successes and complications of arteriovenous fistula (AVF) creation before dialysis initiation is reported. Study cohort: all patients who underwent AVF creation before need for dialysis (AVF group, n = 125). "Control" group: all patients with a sustained glomerular filtration rate (GFR) <or=25 ml/min and eligible for AVF creation during the same time period, but did not have an access placed before dialysis (no AVF group, n = 198). Median nephrology contact time was >12 months in both groups and mean eGFR at creation (AVF group) was 12 ml/min. In the AVF group, 72% underwent a successful first AVF creation, 11% suffered AVF thrombosis, and 17% had a nonmaturing AVF before need for dialysis. Sixty-six percent (n = 23) of these latter patients underwent a second AVF creation and 48% were mature at dialysis initiation. During the study period, 70% (n = 88, AVF group) and 61% (n = 121, no AVF group) commenced dialysis. Impressively, 72% (n = 66) of the AVF group used a mature fistula as their first dialysis access. A snapshot of "access in use" at the 6-month mark of dialysis revealed the AVF group had a higher number of patients using an AVF (81% vs. 44%) and a lower number with catheters (19% vs. 56%, respectively, p = 0.001). In conclusion, the success rate of early AVF creation is reasonable and complications when identified can be remedied without the need for a catheter, thus ultimately maximizing the use of AVF in dialysis patients.
报告了一家机构在透析开始前建立动静脉内瘘（AVF）的成功经验及并发症，为期2年。研究队列：所有在需要透析前接受AVF建立的患者（AVF组，n = 125）。“对照组”：所有肾小球滤过率（GFR）持续≤25 ml/min且在同一时期有资格建立AVF，但在透析前未建立通路的患者（无AVF组，n = 198）。两组的中位肾病接触时间均>12个月，建立AVF时（AVF组）的平均估算肾小球滤过率（eGFR）为12 ml/min。在AVF组中，72%的患者首次AVF建立成功，11%发生AVF血栓形成，17%在需要透析前出现AVF未成熟。后一组患者中有66%（n = 23）进行了第二次AVF建立，48%在透析开始时成熟。在研究期间，70%（n = 88，AVF组）和61%（n = 121，无AVF组）开始透析。令人印象深刻的是，AVF组中有72%（n = 66）的患者将成熟的内瘘作为首次透析通路。透析6个月时“正在使用的通路”情况显示，AVF组使用AVF的患者数量更多（81%对44%），使用导管的患者数量更少（分别为19%对56%，p = 0.001）。总之，早期建立AVF的成功率合理，并发症一旦发现无需使用导管即可纠正，从而最终最大限度地提高了透析患者对AVF的使用率。
