Nephrology Research and Development Unit, Faculty of Medicine, University of Porto & São João Hospital Centre, Alameda Professor Hernani Monteiro, Porto 4202-451, Portugal.
BMC Nephrol. 2012 Aug 23;13:88. doi: 10.1186/1471-2369-13-88.
Although several studies have demonstrated early survival advantages with peritoneal dialysis (PD) over hemodialysis (HD), the reason for the excess mortality observed among incident HD patients remains to be established, to our knowledge. This study explores the relationship between mortality and dialysis modality, focusing on the role of HD vascular access type at the time of dialysis initiation.
A retrospective cohort study was performed among local adult chronic kidney disease patients who consecutively initiated PD and HD with a tunneled cuffed venous catheter (HD-TCC) or a functional arteriovenous fistula (HD-AVF) in our institution in the year 2008. A total of 152 patients were included in the final analysis (HD-AVF, n = 59; HD-TCC, n = 51; PD, n = 42). All cause and dialysis access-related morbidity/mortality were evaluated at one year. Univariate and multivariate analysis were used to compare the survival of PD patients with those who initiated HD with an AVF or with a TCC.
Compared with PD patients, both HD-AVF and HD-TCC patients were more likely to be older (p<0.001) and to have a higher frequency of diabetes mellitus (p = 0.017) and cardiovascular disease (p = 0.020). Overall, HD-TCC patients were more likely to have clinical visits (p = 0.069), emergency room visits (p<0.001) and hospital admissions (p<0.001). At the end of follow-up, HD-TCC patients had a higher rate of dialysis access-related complications (1.53 vs. 0.93 vs. 0.64, per patient-year; p<0.001) and hospitalizations (0.47 vs. 0.07 vs. 0.14, per patient-year; p = 0.034) than HD-AVF and PD patients, respectively. The survival rates at one year were 96.6%, 74.5% and 97.6% for HD-AVF, HD-TCC and PD groups, respectively (p<0.001). In multivariate analysis, HD-TCC use at the time of dialysis initiation was the important factor associated with death (HR 16.128, 95%CI [1.431-181.778], p = 0.024).
Our results suggest that HD vascular access type at the time of renal replacement therapy initiation is an important modifier of the relationship between dialysis modality and survival among incident dialysis patients.
尽管已有多项研究表明腹膜透析（PD）在生存率方面优于血液透析（HD），但导致起始 HD 患者死亡率过高的原因仍有待确定。本研究旨在探讨死亡率与透析方式之间的关系，重点关注起始透析时的 HD 血管通路类型的作用。
对 2008 年在我院连续接受经皮隧道式带涤纶套中心静脉导管（HD-TCC）或功能动静脉瘘（HD-AVF）的本地成年慢性肾脏病患者进行回顾性队列研究。最终有 152 名患者纳入最终分析（HD-AVF，n=59；HD-TCC，n=51；PD，n=42）。所有患者在 1 年内评估全因和与透析通路相关的发病率/死亡率。采用单因素和多因素分析比较 PD 患者与起始 HD 时使用 AVF 或 TCC 的患者的生存情况。
与 PD 患者相比，HD-AVF 和 HD-TCC 患者更可能年龄较大（p＜0.001），糖尿病（p=0.017）和心血管疾病（p=0.020）的发生率更高。总体而言，HD-TCC 患者更可能进行临床就诊（p=0.069）、急诊就诊（p＜0.001）和住院（p＜0.001）。在随访结束时，HD-TCC 患者的透析通路相关并发症发生率（每患者-年 1.53 比 0.93 比 0.64；p＜0.001）和住院率（每患者-年 0.47 比 0.07 比 0.14；p=0.034）均高于 HD-AVF 和 PD 患者。HD-AVF、HD-TCC 和 PD 组的 1 年生存率分别为 96.6%、74.5%和 97.6%（p＜0.001）。多因素分析显示，起始透析时使用 HD-TCC 是与死亡相关的重要因素（HR 16.128，95%CI [1.431-181.778]，p=0.024）。
我们的研究结果表明，起始肾脏替代治疗时的 HD 血管通路类型是影响起始透析患者透析方式与生存率之间关系的重要因素。
