Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
J Vasc Surg. 2018 Jan;67(1):229-235. doi: 10.1016/j.jvs.2017.05.131. Epub 2017 Aug 16.
In addition to age and comorbidities, health-related quality of life (HRQOL) is known to predict mortality in hemodialysis (HD) patients. Understanding the association of vascular access type with HRQOL can help surgeons to provide patient-centered dialysis access recommendations. We sought to understand the impact of HD access type on HRQOL.
We conducted a cross-sectional prospective study of community-dwelling prevalent HD patients in Pittsburgh, Pennsylvania. We assessed patient satisfaction with their access using the Vascular Access Questionnaire (VAQ) and HRQOL with the Short Form Health Survey. We compared access satisfaction and HRQOL across access types. We used logistic regression modeling to evaluate the association of access type with satisfaction and multivariate analysis of variance to evaluate the association of both of these variables on HRQOL.
We surveyed 77 patients. The mean age was 61.8 ± 15.9 years. Arteriovenous fistula (AVF) was used by 62.3%, tunneled dialysis catheter (TDC) by 23.4%, and arteriovenous graft (AVG) by 14.3%. There was a significant difference in satisfaction by access type with lowest median VAQ score (indicating highest satisfaction) in patients with AVF followed by TDC and AVG (4.5 vs 6.5 vs 7.0; P = .013). Defining a VAQ score of <7 to denote satisfaction, AVF patients were more likely to be satisfied with their access, compared with TDC or AVG (77% vs 56% vs 55%; P = NS). Multivariate regression analysis yielded a model that predicted 46% of the variance of VAQ score; important predictors of dissatisfaction included <1 year on dialysis (β = 3.36; P < .001), increasing number of access-related hospital admissions in the last year (β = 1.69; P < .001), and AVG (β = 1.72; P = .04) or TDC (β = 1.67; P = .02) access. Mean physical and mental QOL scores (the composite scores of Short Form Health Survey) were not different by access type (P = .49; P = .41). In an additive multivariate analysis of variance with the two composite QOL scores as dependent variables, 25.8% of the generalized variance in HRQOL (effect size) was accounted for by access satisfaction with only an additional 3% accounted for by access type.
HD patients experience greatest satisfaction with fistula, and access satisfaction is significantly associated with better HRQOL. Controlling for access satisfaction, there is no significant independent association of access type on HRQOL. Future research should investigate the relationship between access satisfaction, adherence to dialysis regimens, mortality, and the consequent implications for patient-centered care.
除年龄和合并症外，健康相关生活质量（HRQOL）也已知可预测血液透析（HD）患者的死亡率。了解血管通路类型与 HRQOL 的关系有助于外科医生为患者提供以中心为导向的透析通路建议。我们旨在了解 HD 通路类型对 HRQOL 的影响。
我们对宾夕法尼亚州匹兹堡的社区居住的现患 HD 患者进行了一项横断面前瞻性研究。我们使用血管通路问卷（VAQ）评估患者对其通路的满意度，并用简短健康调查评估 HRQOL。我们比较了不同通路类型的通路满意度和 HRQOL。我们使用逻辑回归模型评估通路类型与满意度之间的关联，使用方差分析评估这两个变量与 HRQOL 之间的关联。
我们调查了 77 名患者。平均年龄为 61.8±15.9 岁。动静脉瘘（AVF）使用率为 62.3%，隧道透析导管（TDC）使用率为 23.4%，动静脉移植物（AVG）使用率为 14.3%。不同通路类型的满意度存在显著差异，AVF 患者的 VAQ 中位数评分最低（表示满意度最高），其次是 TDC 和 AVG（4.5 分 vs 6.5 分 vs 7.0 分；P=0.013）。定义 VAQ 评分<7 表示满意，与 TDC 或 AVG 相比，AVF 患者更可能对其通路满意（77% vs 56% vs 55%；P=NS）。多元回归分析得出了一个可以预测 VAQ 评分 46%的模型；不满意的重要预测因素包括透析时间<1 年（β=3.36；P<0.001）、去年与通路相关的住院次数增加（β=1.69；P<0.001）以及 AVG（β=1.72；P=0.04）或 TDC（β=1.67；P=0.02）通路。不同通路类型的生理和心理 QOL 评分（简短健康调查的综合评分）无差异（P=0.49；P=0.41）。在依赖于两个综合 QOL 评分的加性方差分析中，通路满意度解释了 HRQOL 总体变异的 25.8%（效应大小），通路类型仅解释了另外的 3%。
HD 患者对瘘管的满意度最高，而通路满意度与更好的 HRQOL 显著相关。控制通路满意度后，通路类型对 HRQOL 没有显著的独立关联。未来的研究应探讨通路满意度、对透析方案的依从性、死亡率以及对以患者为中心的护理的影响之间的关系。
