Zouaghi Mohamed Karim, Lammouchi Mohamed Ali, Hassan Mohanad, Rais Lamia, Krid Madiha, Smaoui Wided, Jebali Hela, Kheder Rania, Hamida Fethi Ben, Moussa Fatma Ben, Fatma Lilia Ben, Beji Soumaya
Department of Nephrology, Dialysis and Kidney Transplantation, Rabta Hospital, Tunis, Tunisia.
Research Laboratory of Renal Pathology LR00SP01, Tunis Medical School, Tunis el Manar University, Tunis, Tunisia.
Saudi J Kidney Dis Transpl. 2018 May-Jun;29(3):615-622. doi: 10.4103/1319-2442.235183.
The arteriovenous fistula (AVF) is the vascular access of the first choice for hemodialysis (HD). Studies on patency of AVF and its affecting factors reveal a high risk for access failure. The aim of this study was to assess the primary and secondary AVF patency and their determinant factors. It was a retrospective, descriptive study conducted in the HD facility of the Nephrology Department in Rabta University Hospital. We included AVF created before December 2009 in end-stage renal disease (ESRD) patients. The end of the follow-up was fixed in December 2013. We included 126 AVFs created in 111 patients; 22.5% were aged >65 years, 39.6% were diabetic, 68.5% were hypertensive, and 26.1% had peripheral vascular disease. The primary patency rates were 78% at one year and 42% at five years. The secondary patency rates were 80% at one year and 69% at five years. Multivariate analysis revealed that the factors affecting the primary patency of AVF were: the use of jugular catheter for longer than three months (odds ratio (OR):1.91, P = 0.044) and a C-reactive protein >5 mg/L (OR: 1.7, P = 0.049). Aging (>65 years) (OR: 2.46, P = 0.042), referral time to a nephrologist <6 months before onset of ESRD (OR: 2.87, P = 0.015), absence of an antiplatelet therapy (OR: 4.47, P = 0.005), and serum phosphorus <45 mg/L (OR: 2.07, P = 0.045) were the significant impairing risk factors for secondary AVF patency. Our study suggests that early referral and creation of AVF and maturation before ESRD as well as its adequate monitoring are essential for maintaining patency.
动静脉内瘘（AVF）是血液透析（HD）的首选血管通路。关于AVF通畅性及其影响因素的研究表明，通路失败风险很高。本研究的目的是评估原发性和继发性AVF的通畅性及其决定因素。这是一项在拉卜塔大学医院肾病科血液透析设施中进行的回顾性描述性研究。我们纳入了2009年12月前为终末期肾病（ESRD）患者建立的AVF。随访截止于2013年12月。我们纳入了111例患者建立的126个AVF；22.5%的患者年龄>65岁，39.6%为糖尿病患者，68.5%为高血压患者，26.1%患有周围血管疾病。原发性通畅率1年时为78%，5年时为42%。继发性通畅率1年时为80%，5年时为69%。多因素分析显示，影响AVF原发性通畅的因素为：使用颈内静脉导管超过3个月（比值比（OR）：1.91，P = 0.044）和C反应蛋白>5 mg/L（OR：1.7，P = 0.049）。年龄>65岁（OR：2.46，P = 0.042）、ESRD发病前<6个月转诊至肾病科的时间（OR：2.87，P = 0.015）、未进行抗血小板治疗（OR：4.47，P = 0.005）以及血清磷<45 mg/L（OR：2.07，P = 0.045）是继发性AVF通畅的显著损害危险因素。我们的研究表明，ESRD之前尽早转诊并建立AVF以及使其成熟，以及对其进行充分监测对于维持通畅至关重要。
