Yen Cheng-Chieh, Liu Mei-Yin, Chen Po-Wei, Hung Peir-Haur, Su Tse-Hsuan, Hsu Yueh-Han
Division of Nephrology, Department of Internal Medicine, Ditmansion Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan.
Health Center, Municipal Jingliau Junior High School, Tainan City, Taiwan.
PeerJ. 2019 Apr 3;7:e6680. doi: 10.7717/peerj.6680. eCollection 2019.
Cardiovascular (CV) disease contributes to nearly half of the mortalities in patients with end-stage renal disease. Patients who received prehemodialysis arteriovenous access (pre-HD AVA) creation had divergent CV outcomes.
We conducted a population-based cohort study by recruiting incident patients receiving HD from 2001 to 2012 from the Taiwan National Health Insurance Research Database. Patients' characteristics, comorbidities, and medicines were analyzed. The primary outcome of interest was major adverse cardiovascular events (MACEs), defined as hospitalization due to acute myocardial infarction, stroke, or congestive heart failure (CHF) occurring within the first year of HD. Secondary outcomes included MACE-related mortality and all-cause mortality in the same follow-up period.
The patients in the pre-HD AVA group were younger, had a lower burden of underlying diseases, were more likely to use erythropoiesis-stimulating agents but less likely to use renin-angiotensin-aldosterone system blockers. The patients with pre-HD AVA creation had a marginally lower rate of MACEs but a significant 35% lower rate of CHF hospitalization than those without creation (adjusted hazard ratio (HR) 0.65, 95% confidence interval (CI) [0.48-0.88]). In addition, the pre-HD AVA group exhibited an insignificantly lower rate of MACE-related mortality but a significantly 52% lower rate of all-cause mortality than the non-pre-HD AVA group (adjusted HR 0.48, 95% CI [0.39-0.59]). Sensitivity analyses obtained consistent results.
Pre-HD AVA creation is associated with a lower rate of CHF hospitalization and overall death in the first year of dialysis.
心血管疾病导致终末期肾病患者近一半的死亡。接受血液透析前动静脉通路（pre-HD AVA）建立的患者心血管结局存在差异。
我们通过从台湾国民健康保险研究数据库招募2001年至2012年开始接受血液透析的新发病例患者，进行了一项基于人群的队列研究。分析了患者的特征、合并症和用药情况。感兴趣的主要结局是主要不良心血管事件（MACE），定义为血液透析第一年因急性心肌梗死、中风或充血性心力衰竭（CHF）住院。次要结局包括同一随访期内与MACE相关的死亡率和全因死亡率。
pre-HD AVA组患者更年轻，基础疾病负担更低，更可能使用促红细胞生成素，但使用肾素-血管紧张素-醛固酮系统阻滞剂的可能性更小。与未建立pre-HD AVA的患者相比，建立pre-HD AVA的患者MACE发生率略低，但CHF住院率显著降低35%（调整后风险比（HR）0.65，95%置信区间（CI）[0.48 - 0.88]）。此外，pre-HD AVA组与MACE相关的死亡率略低，但全因死亡率比非pre-HD AVA组显著降低52%（调整后HR 0.48，95% CI [0.39 - 0.59]）。敏感性分析得到了一致的结果。
血液透析前建立AVA与透析第一年较低的CHF住院率和总体死亡率相关。
