Balamuthusamy Saravanan, Miller Larry E, Clynes Diana, Kahle Erin, Knight Richard A, Conway Paul T
Vascular and Interventional Nephrology, Tarrant Vascular Access Center, Fort Worth, TX, USA.
Texas Research Institute, PPG Healthcare PA, Fort Worth, TX, USA.
J Vasc Access. 2020 Mar;21(2):230-236. doi: 10.1177/1129729819870962. Epub 2019 Aug 29.
To determine the vascular access modalities used for hemodialysis, the reasons for choosing them, and determinants of satisfaction with vascular access among patients with end-stage renal disease.
The American Association of Kidney Patients Center for Patient Research and Education used the American Association of Kidney Patients patient engagement database to identify eligible adult hemodialysis patients. Participants completed an online survey consisting of 34 demographic, medical history, and hemodialysis history questions to determine which vascular access modalities were preferred and the reasons for these preferences.
Among 150 respondents (mean age 54 years, 53% females), hemodialysis was most frequently initiated with central venous catheter (64%) while the most common currently used vascular access was arteriovenous fistula (66%). Most (86%) patients previously received an arteriovenous fistula, among whom 77% currently used the arteriovenous fistula for vascular access. Older patients and males were more likely to initiate hemodialysis with an arteriovenous fistula. The factors most frequently reported as important in influencing the selection of vascular access modality included infection risk (87%), physician recommendation (84%), vascular access durability (78%), risk of complications involving surgery (76%), and impact on daily activities (73%); these factors were influenced by patient age, sex, and race. Satisfaction with current vascular access was 90% with arteriovenous fistula, 79% with arteriovenous graft, and 67% with central venous catheter.
Most end-stage renal disease patients continue to initiate hemodialysis with central venous catheter despite being associated with the lowest satisfaction rates. While arteriovenous fistula was associated with the highest satisfaction rate, there are significant barriers to adoption that vary based on patient demographics and perception of procedure invasiveness.
确定终末期肾病患者用于血液透析的血管通路方式、选择这些方式的原因以及血管通路满意度的决定因素。
美国肾病患者协会患者研究与教育中心利用美国肾病患者协会患者参与数据库来确定符合条件的成年血液透析患者。参与者完成了一项在线调查，该调查包含34个关于人口统计学、病史和血液透析史的问题，以确定哪种血管通路方式更受青睐以及这些偏好的原因。
在150名受访者（平均年龄54岁，53%为女性）中，血液透析最常起始于中心静脉导管（64%），而目前最常用的血管通路是动静脉内瘘（66%）。大多数（86%）患者之前接受过动静脉内瘘手术，其中77%目前使用动静脉内瘘作为血管通路。老年患者和男性更有可能起始于动静脉内瘘进行血液透析。在影响血管通路方式选择的因素中，最常被报告为重要的因素包括感染风险（87%）、医生建议（84%）、血管通路耐用性（78%）、手术相关并发症风险（76%）以及对日常活动的影响（73%）；这些因素受患者年龄、性别和种族的影响。对当前血管通路的满意度方面，动静脉内瘘为90%，动静脉移植物为79%，中心静脉导管为67%。
尽管中心静脉导管的满意度最低，但大多数终末期肾病患者仍继续起始于中心静脉导管进行血液透析。虽然动静脉内瘘的满意度最高，但采用动静脉内瘘存在显著障碍，这些障碍因患者人口统计学特征和对手术侵入性的认知而异。
