Momeni Ali, Mardani Saeed, Kabiri Maryam, Amiri Masoud
Division of Nephrology, Department of Internal Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran.
Department of Internal Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran.
Adv Biomed Res. 2017 Aug 28;6:106. doi: 10.4103/2277-9175.213666. eCollection 2017.
Arteriovenous fistula (AVF), permanent catheter (PC), and vascular graft are three vascular access types used for hemodialysis procedure. Due to insufficient reliable information on the comparison between AVF and PC, this study was conducted to compare AVF and PC regarding dialysis adequacy.
This prospective study was carried out from March, 2013 to September, 2013. In this study, 76 hemodialysis patients were enrolled and assigned to two unequal groups of AVF and PC. Before and after the dialysis session, blood samples were taken for laboratory examinations and measurement of urea reduction ratio (URR) and Kt/V. The patients were followed up for six months, and then laboratory examinations were repeated.
Of the 76 hemodialysis patients, 30 had AVF and others PC. During the 6-month follow-up, 24 patients in PC group but only one patient in AVF group showed infection ( = 0.006), while in each group, three cases of thrombosis were seen ( = 0.58); however, catheter dysfunction was seen in 13 patients of PC group but no patients of AVF group ( = 0.004). There was no difference between the two groups in Kt/V and URR at the beginning of the study; however, after six months, Kt/V and URR were greater in AVF group ( < 0.05).
In addition to some advantages of AVF over PC, such as lower rate of infection and thrombosis, we also found better dialysis adequacy in AVF group. We recommend that AVF be created in all of patients with chronic kidney disease who are candidates for hemodialysis.
动静脉内瘘(AVF)、永久性导管(PC)和血管移植物是用于血液透析程序的三种血管通路类型。由于关于AVF和PC之间比较的可靠信息不足,本研究旨在比较AVF和PC在透析充分性方面的差异。
本前瞻性研究于2013年3月至2013年9月进行。在本研究中,76例血液透析患者被纳入并分为AVF和PC两个不等的组。在透析前后,采集血样进行实验室检查并测量尿素清除率(URR)和Kt/V。对患者进行为期6个月的随访,然后重复实验室检查。
76例血液透析患者中,30例有AVF,其余有PC。在6个月的随访期间,PC组有24例患者发生感染,而AVF组仅有1例患者发生感染(P = 0.006),而每组均有3例血栓形成(P = 0.58);然而,PC组有13例患者出现导管功能障碍,而AVF组无患者出现(P = 0.004)。研究开始时两组的Kt/V和URR无差异;然而,6个月后,AVF组的Kt/V和URR更高(P < 0.05)。
除了AVF相对于PC的一些优势,如较低的感染率和血栓形成率外,我们还发现AVF组的透析充分性更好。我们建议在所有适合血液透析的慢性肾病患者中建立AVF。