Praehauser Claudia, Breidthardt Tobias, Moser-Bucher Cora Nina, Wolff Thomas, Baechler Katrin, Eugster Thomas, Dickenmann Michael, Gurke Lorenz, Mayr Michael
Medical Outpatient Department , University Hospital Basel , Basel , Switzerland.
Clinic for Transplantation Immunology and Nephrology , University Hospital Basel , Basel , Switzerland.
Clin Kidney J. 2012 Aug;5(4):339-46. doi: 10.1093/ckj/sfs055. Epub 2012 Jun 28.
The American Fistula First Breakthrough Initiative currently aims for a 66% arterio-venous fistula (AVF) rate, while in the UK, best practice tariffs target AVF and arterio-venous graft (AVG) rates of 85%. The present study aims to assess whether these goals can be achieved.
We conducted a retrospective cohort study on patients who initiated haemodialysis from 1995 to 2006. Outcomes were the final failure-free survival of the first permanent access and the type of second access created. Prevalent use rates for the access types were calculated on the 1st January of each year for the second half of the study period.
Two hundred and eleven out of 246 patients (86%) received an AVF, 16 (6%) an AVG and 19 (8%) a permanent catheter (PC) as the first permanent access. Eighty-six (35%) patients had final failure of the primary access. One- and 3-year final failure-free survival rates were 73 and 65% for AVF compared with 40 and 20% for AVG and 62 and 0% for PC, respectively. In patients with primary AVF, female sex {hazard ratio (HR) 2.20 [confidence interval (CI) 1.29-3.73]} and vascular disease [HR 2.24 (CI 1.26-3.97)] were associated with a poorer outcome. A similar trend was observed for autoimmune disease [HR 2.14 (CI 0.99-4.65)]. As second accesses AVF, AVG and PC were created in 47% (n = 40), 38% (n = 33) and 15% (n = 13). The median prevalent use rate was 80.5% for AVF, 14% for AVG and 5.5% for PC.
The vascular access targets set by initiatives from the USA and UK are feasible in unselected haemodialysis patients. High primary AVF rates, the superior survival rates of AVFs even in patient groups at higher risk of access failure and the high rate of creation of secondary AVFs contributed to these promising results.
美国“内瘘优先突破计划”目前的目标是实现66%的动静脉内瘘（AVF）使用率，而在英国，最佳实践收费标准的目标是AVF和动静脉移植物（AVG）使用率达到85%。本研究旨在评估这些目标是否能够实现。
我们对1995年至2006年开始进行血液透析的患者进行了一项回顾性队列研究。观察指标为首次永久性血管通路的最终无故障生存期以及建立的第二次血管通路的类型。在研究期后半段的每年1月1日计算各种血管通路类型的普遍使用率。
246例患者中有211例（86%）接受了AVF作为首次永久性血管通路，16例（6%）接受了AVG，19例（8%）接受了永久性导管（PC）。86例（35%）患者的初次血管通路最终失败。AVF的1年和3年最终无故障生存率分别为73%和65%，而AVG分别为40%和20%，PC分别为62%和0%。在初次使用AVF的患者中，女性{风险比（HR）2.20 [置信区间（CI）1.29 - 3.73]}和血管疾病[HR 2.24（CI 1.26 - 3.97）]与较差的预后相关。自身免疫性疾病也观察到类似趋势[HR 2.14（CI 0.99 - 4.65）]。作为第二次血管通路，分别有47%（n = 40）建立了AVF，38%（n = 33）建立了AVG，15%（n = 13）建立了PC。AVF的中位普遍使用率为80.5%，AVG为14%，PC为5.5%。
美国和英国倡议设定的血管通路目标在未经选择的血液透析患者中是可行的。较高的初次AVF使用率、即使在血管通路失败风险较高的患者群体中AVF仍具有较高的生存率以及二次AVF的高建立率促成了这些令人鼓舞的结果。
