Faculdade de Medicina, Universidade Federal de Minas Gerais, Brazil.
BMC Nephrol. 2011 Nov 17;12:63. doi: 10.1186/1471-2369-12-63.
For chronic hemodialysis, the ideal permanent vascular access is the arteriovenous fistula (AVF). Temporary catheters should be reserved for acute dialysis needs. The AVF is associated with lower infection rates, better clinical results, and a higher quality of life and survival when compared to temporary catheters. In Brazil, the proportion of patients with temporary catheters for more than 3 months from the beginning of therapy is used as an evaluation of the quality of renal units. The aim of this study is to evaluate factors associated with the time between the beginning of hemodialysis with temporary catheters and the placement of the first arteriovenous fistula in Brazil.
This is an observational, prospective non-concurrent study using national administrative registries of all patients financed by the public health system who began renal replacement therapy (RRT) between 2000 and 2004 in Brazil. Incident patients were eligible who had hemodialysis for the first time. Patients were excluded who: had hemodialysis reportedly started after the date of death (inconsistent database); were younger than 18 years old; had HIV; had no record of the first dialysis unit; and were dialyzed in units with less than twenty patients. To evaluate individual and renal unit factors associated with the event of interest, the frailty model was used (N = 55,589).
Among the 23,824 patients (42.9%) who underwent fistula placement in the period of the study, 18.2% maintained the temporary catheter for more than three months until the fistula creation. The analysis identified five statistically significant factors associated with longer time until first fistula: higher age (Hazard-risk - HR 0.99, 95% CI 0.99-1.00); having hypertension and cardiovascular diseases (HR 0.94, 95% CI 0.9-0.98) as the cause of chronic renal disease; residing in capitals cities (HR 0.92, 95% CI 0.9-0.95) and certain regions in Brazil - South (HR 0.83, 95% CI 0.8-0.87), Midwest (HR 0.88, 95% CI 0.83-0.94), Northeast (HR 0.91, 95% CI 0.88-0.94), or North (HR 0.88, 95% CI 0.83-0.94) and the type of renal unit (public or private).
Monitoring the provision of arteriovenous fistulas in renal units could improve the care given to patients with end stage renal disease.
对于慢性血液透析，理想的永久性血管通路是动静脉瘘（AVF）。临时导管应保留用于急性透析需求。与临时导管相比，AVF 与较低的感染率、更好的临床结果以及更高的生活质量和生存率相关。在巴西，从开始治疗开始超过 3 个月的患者使用临时导管的比例被用作评估肾脏单位质量的指标。本研究的目的是评估巴西患者开始使用临时导管进行血液透析与首次放置动静脉瘘之间时间的相关因素。
这是一项观察性、前瞻性非同期研究，使用巴西国家公共卫生系统资助的所有患者的所有患者的国家行政登记处，这些患者在 2000 年至 2004 年间开始接受肾脏替代治疗（RRT）。合格的患者是首次接受血液透析的患者。排除有以下情况的患者：据数据库记录显示，患者在死亡日期后开始血液透析（数据库不一致）；年龄小于 18 岁；患有 HIV；没有首次透析单位的记录；在患者少于 20 人的单位进行透析。为了评估与感兴趣事件相关的个体和肾脏单位因素，使用脆弱性模型（N=55589）。
在研究期间接受瘘管放置的 23824 名患者（42.9%）中，有 18.2%的患者将临时导管保留超过三个月，直到建立瘘管。分析确定了五个与首次瘘管形成时间较长相关的统计学显著因素：年龄较高（风险比- HR 0.99，95%CI 0.99-1.00）；高血压和心血管疾病（HR 0.94，95%CI 0.9-0.98）是慢性肾病的病因；居住在首都城市（HR 0.92，95%CI 0.9-0.95）和巴西某些地区-南部（HR 0.83，95%CI 0.8-0.87），中西部（HR 0.88，95%CI 0.83-0.94），东北部（HR 0.91，95%CI 0.88-0.94）或北部（HR 0.88，95%CI 0.83-0.94）和肾脏单位类型（公共或私人）。
监测肾脏单位中动静脉瘘的提供情况可以改善对终末期肾病患者的护理。
