UK Renal Registry, Southmead Hospital, Bristol, UK.
Nephron Clin Pract. 2011;119 Suppl 2:c135-40. doi: 10.1159/000331757. Epub 2011 Aug 26.
The type of vascular access used by haemodialysis patients is thought to be one of the predictors of patient survival. However, many previous studies have been unable to separate the effect of access type from the effects of other differences between patients groups or have included incident patients. Some centres report excellent outcomes using dialysis catheters in stable prevalent patients and challenge the current guidelines about the use of long term catheters. This is an observational UK centre level study reporting on the relationship between the percentage of established prevalent patients using definitive access and the subsequent 1 year survival.
Vascular access audit data from 2005 and UKRR survival data at 1 year for patients who had been on HD for over 3 months was obtained from the UKRR database. Regression analysis was used to assess the amount of variation in 1 year survival that could be explained by the percentage of patients using an AVF or AVG in a centre.
From the renal centres reporting to the UKRR in 2005, 16,984 patients had vascular access data. The mean centre level 1 year survival was 86.4% (95% CI: 82.2-90.9) and was 86.9% (95% CI: 82.8-91.2) after censoring for transplantation. The mean percentage of haemodialysis patients using definitive access (AVF or AVG) in a centre was 69.8% (SD 10.4). A small positive association was found between the percentage of HD patients using an AVF or AVG in a centre and 1 year uncensored survival (β = 0.06, p = 0.04). The type of access in use was able to explain 6% of the variation in centre level survival.
To some extent, this study has repeated work done by DOPPS and in the US but for the first time has studied only prevalent dialysis patients and looked at the UK dialysis population. Whilst increased venous catheter use was associated with an increase in one year mortality of prevalent established haemodialysis patients, this effect was very small and only accounted for some 6% of the variation in one year mortality between renal centres. Further work using data from the current large vascular access audit needs to be done to further elucidate best practice within the UK.
接受血液透析的患者所使用的血管通路类型被认为是预测患者生存率的因素之一。然而，许多先前的研究未能将通路类型的影响与患者群体之间的其他差异的影响分开，或者包括了新发病例。一些中心报告称，在稳定的现有患者中使用透析导管可获得良好的结果，并对目前关于长期导管使用的指南提出了挑战。这是一项观察性的英国中心水平研究，报告了在确定的现有患者中使用永久性通路的百分比与随后的 1 年生存率之间的关系。
从 UKRR 数据库中获取了 2005 年血管通路审核数据和超过 3 个月接受血液透析治疗的患者的 UKRR 生存数据。回归分析用于评估中心内使用动静脉瘘或动静脉移植物的患者百分比对 1 年生存率的变异量的解释程度。
在 2005 年向 UKRR 报告的肾脏中心中，有 16984 名患者有血管通路数据。中心水平 1 年生存率的平均值为 86.4%（95%置信区间：82.2-90.9），在移植后进行删失时为 86.9%（95%置信区间：82.8-91.2）。中心内使用永久性通路（动静脉瘘或动静脉移植物）的血液透析患者的平均百分比为 69.8%（标准差 10.4）。中心内使用动静脉瘘或动静脉移植物的血液透析患者百分比与未删失的 1 年生存率之间存在微弱的正相关（β=0.06，p=0.04）。通路类型的使用能够解释中心水平生存率变异的 6%。
在某种程度上，这项研究重复了 DOPPS 和美国所做的工作，但首次仅研究了现有的透析患者，并观察了英国的透析人群。虽然静脉导管的使用增加与现有血液透析患者 1 年死亡率的增加相关，但这种影响非常小，仅占肾脏中心之间 1 年死亡率变异的约 6%。需要使用当前大规模血管通路审核的数据进一步开展工作，以进一步阐明英国的最佳实践。
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