David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, Calif., USA.
J Vasc Surg. 2012 Aug;56(2):424-31; discussion 431-2. doi: 10.1016/j.jvs.2012.01.029. Epub 2012 May 1.
The National Kidney Foundation recommends that arteriovenous fistulas (AVFs) be placed in at least 65% of hemodialysis patients. Some studies suggest that African American patients are less likely to receive a first-time AVF than patients of other ethnicities, although the reason for this disparity is unclear. The purpose of our study is to determine (1) whether there are ethnic differences in AVF creation, (2) whether this may be related to differences in vein diameters, and (3) whether AVF patency rates are similar between African American and non-African American male patients.
Consecutive male patients undergoing first-time hemodialysis access from 2006 to 2010 at two institutions were retrospectively reviewed. Data collected included age, ethnicity, weight, height, body mass index, diabetes, hypertension, congestive heart failure, smoking history, intravenous drug abuse, need for temporary access placement, and preoperative venous ultrasound measurements. Categoric variables were compared using χ(2) analysis, and the Wilcoxon rank-sum test was used to compare continuous variables.
Of 249 male patients identified, 95 were African American. Median age in African American and non-African American patients was 63 years. Hypertension and hyperlipidemia were statistically significantly greater in African American patients. The need for temporary access before hemoaccess was similar between the cohorts. African American patients demonstrated significantly smaller median basilic and cephalic vein diameters at most measured sites. Overall, 221 of 249 (88.8%) underwent AVF first. An AV graft was created in 17.9% of African American patients vs in only 7.1% of non-African Americans (odds ratio, 2.8; 95% confidence interval, 1.3-6.4; P = .009). The difference between median vein diameters used for autologous fistula creation in African American and non-African American patients was not significant. There was no significant difference in the primary patency (80.8% vs 76.2%; P = .4), primary functional patency (73.1% vs 69.2%; P = .5), or secondary functional patency rates (91.0% vs 96.5%; P = .1). Average primary fistula survival time was 257 days in African American and 256 in non-African American patients (P = .2).
African American patients are less likely than non-African American patients to undergo AVF during first-time hemodialysis access surgery. This ethnic discrepancy appears to be due to smaller arm vein diameters in African American patients. In African American patients with appropriate vein diameters who do undergo AVF, primary and functional patencies are equivalent to non-African American patients.
美国肾脏基金会建议，至少有 65%的血液透析患者应建立动静脉瘘（AVF）。一些研究表明，与其他族裔的患者相比，非裔美国人患者接受首次动静脉瘘的可能性较低，尽管造成这种差异的原因尚不清楚。我们研究的目的是确定：（1）在建立动静脉瘘方面是否存在种族差异；（2）这种差异是否与静脉直径的差异有关；（3）非裔美国男性患者和非非裔美国男性患者的动静脉瘘通畅率是否相似。
回顾性分析了 2006 年至 2010 年间在两家机构接受首次血液透析通路的连续男性患者的数据。收集的数据包括年龄、族裔、体重、身高、体重指数、糖尿病、高血压、充血性心力衰竭、吸烟史、静脉内药物滥用、临时通路放置的需要以及术前静脉超声测量。采用卡方检验比较分类变量，采用 Wilcoxon 秩和检验比较连续变量。
在确定的 249 名男性患者中，95 名是非裔美国人。非裔美国人和非非裔美国患者的中位年龄为 63 岁。高血压和高血脂在非裔美国人患者中统计学上更为显著。在接受血液通路治疗之前，两组患者需要临时通路的情况相似。非裔美国患者在大多数测量部位的正中静脉和头静脉直径明显较小。总体而言，249 名患者中有 221 名（88.8%）首先建立了动静脉瘘。17.9%的非裔美国患者建立了动静脉移植物，而非非裔美国人患者仅为 7.1%（比值比，2.8；95%置信区间，1.3-6.4；P =.009）。非裔美国人和非非裔美国患者用于自体瘘的静脉直径中位数之间的差异无统计学意义。非裔美国患者的原发性通畅率（80.8% vs 76.2%；P =.4）、原发性功能通畅率（73.1% vs 69.2%；P =.5）和继发性功能通畅率（91.0% vs 96.5%；P =.1）之间无显著差异。非裔美国患者的平均原发性瘘管生存时间为 257 天，而非非裔美国患者为 256 天（P =.2）。
与非非裔美国患者相比，非裔美国患者在首次血液透析通路手术中更不可能建立动静脉瘘。这种族差异似乎是由于非裔美国患者的手臂静脉直径较小所致。在接受适当静脉直径的动静脉瘘治疗的非裔美国患者中，原发性和功能性通畅率与非非裔美国患者相当。
