David Paola, Navino Carlo, Capurro Federica, De Mauri Andreana, Chiarinotti Doriana, Ruva Carlo Edoardo, De Maria Mariangela, Brustia Maddalena, De Leo Martino
S.C.O. Nefrologia e Dialisi, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.
G Ital Nefrol. 2010 Sep-Oct;27(5):522-6.
With 135 million cases the prevalence of diabetes mellitus (DM) is very high worldwide. Diabetic nephropathy is a major complication of DM. In many countries diabetic nephropathy has become the most frequent cause of endstage renal disease. It is believed that in diabetic patients the creation of a native vascular access (NVA) might be difficult. We evaluated 274 occurrences of NVA creation during the period January 2003 to December 2008: 68 in diabetic patients (group 1) and 206 in nondiabetics (group 2). We compared the type of NVA, primary failure, and primary patency in these groups. Age was significantly higher in diabetic patients (68 vs 64 years; p < 0.05). No statistical differences in primary failure between groups were found for any NAV. Wrist vascular access survival rates were higher in diabetic versus nondiabetic patients (56.9% vs 20.7% at 72 months). No statistical differences were observed between groups in primary patency rates for middle- and upper-arm vascular access. According to our experience diabetes does not lead to additional difficulties in the creation of permanent vascular access, provided proper physical and instrumental examination is performed. Despite the advanced age of the diabetic patients in our study, wrist vascular access showed better results in this group than in nondiabetic patients on long-term follow-up.
全球糖尿病（DM）病例达1.35亿，其患病率非常高。糖尿病肾病是糖尿病的主要并发症。在许多国家，糖尿病肾病已成为终末期肾病最常见的病因。据信，糖尿病患者建立自体血管通路（NVA）可能存在困难。我们评估了2003年1月至2008年12月期间274例NVA建立情况：糖尿病患者68例（第1组），非糖尿病患者206例（第2组）。我们比较了这些组中NVA的类型、初次失败率和初次通畅率。糖尿病患者的年龄显著更高（68岁对64岁；p<0.05）。对于任何NVA，两组之间在初次失败率方面未发现统计学差异。糖尿病患者的腕部血管通路生存率高于非糖尿病患者（72个月时为56.9%对20.7%）。两组之间在中上臂血管通路的初次通畅率方面未观察到统计学差异。根据我们的经验，只要进行适当的体格和器械检查，糖尿病不会给建立永久性血管通路带来额外困难。尽管我们研究中的糖尿病患者年龄较大，但在长期随访中，该组的腕部血管通路效果优于非糖尿病患者。
