Farooq Zahid, Mehmood Arshad, Saeed Shahzad, Raja Khalid Mehmood, Khan Malik Nadeem Azam, Murtaza Badar
Military Hospital, Rawalpindi, Pakistan.
J Ayub Med Coll Abbottabad. 2010 Jul-Sep;22(3):179-81.
Haemodialysis is the primary mode of renal replacement therapy for patients of end stage renal disease. The most important determinant for effective haemodialysis is a reliable vascular access. Arterio-venous (AV) fistula is the closest to be an ideal long-term haemodialysis vascular access. The creation of fistulas or grafts is recommended before starting haemodialysis, this study was undertaken to determine the impact of timing of AV fistula creation on its failure rate.
It is a descriptive study. All patients with chronic kidney disease (CKD) reporting to Armed Forces Institute of Urology (AFIU) and Military Hospital (MH) Rawalpindi from January 2008 to October 2009 in whom vascular access was created were included. The patients were followed prospectively and a complete data about their haemodialysis and vascular access was maintained.
A total of 168 permanent accesses were created in 112 patients in this study. The mean duration of follow-up was 14.05 +/- 4.45 months. Early access creation group included 23 patients and late access creation group included 89 patients. Out of 168 fistulas that were created, 54 fistulas failed with 45 (83.3%) of these from patients of late access creation group. Age, gender and diabetes mellitus (DM) had no significant affect on failure rate of fistulas.
Timely referral to nephrologists and early creation of permanent vascular access by dedicated team work can improve the success rate of AV fistulae so enhancing quality of life of patients of end stage renal disease.
血液透析是终末期肾病患者肾脏替代治疗的主要方式。有效血液透析的最重要决定因素是可靠的血管通路。动静脉内瘘最接近理想的长期血液透析血管通路。建议在开始血液透析前建立内瘘或移植血管，本研究旨在确定动静脉内瘘建立时机对其失败率的影响。
这是一项描述性研究。纳入2008年1月至2009年10月期间到武装部队泌尿外科研究所（AFIU）和拉瓦尔品第军事医院（MH）就诊并建立血管通路的所有慢性肾脏病（CKD）患者。对患者进行前瞻性随访，并保存有关其血液透析和血管通路的完整数据。
本研究共112例患者建立了168条永久性血管通路。平均随访时间为14.05±4.45个月。早期建立血管通路组包括23例患者，晚期建立血管通路组包括89例患者。在建立的168条内瘘中，54条内瘘失败，其中45条（83.3%）来自晚期建立血管通路组的患者。年龄、性别和糖尿病对内瘘失败率无显著影响。
及时转诊至肾病科医生并通过专业团队合作早期建立永久性血管通路可提高动静脉内瘘的成功率，从而提高终末期肾病患者的生活质量。
