Jeong Seonjeong, Kwon Hyunwook, Chang Jai Won, Kim Min-Ju, Ganbold Khaliun, Han Youngjin, Kwon Tae-Won, Cho Yong-Pil
Department of Surgery.
Department of Internal Medicine.
Medicine (Baltimore). 2019 Nov;98(48):e18216. doi: 10.1097/MD.0000000000018216.
This study compared clinical outcomes of patient survival and arteriovenous fistula (AVF) patency between incident hemodialysis patients with and without type 2 diabetes mellitus (T2DM).Between January 2011 and December 2013, 384 consecutive incident hemodialysis patients with confirmed first upper-extremity AVF placement were divided into a T2DM group (n = 180, 46.9%) and a non-DM group (n = 204, 53.1%) and analyzed retrospectively. The primary outcome was all-cause mortality, and secondary outcome was AVF patency.Patients in the T2DM group had a higher prevalence of hypertension (P = .02), smoking (P < .01), cardiovascular disease (P < .01), history of cerebrovascular accident (CVA) (P < .01), and peripheral arterial occlusive disease (P < .01) than those in the non-DM group. On Kaplan-Meier survival analysis, the overall survival and AVF patency rates were significantly higher in the non-DM group relative to the T2DM group (both P < .01). In the adjusted model, older age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.02-1.06; P < .01), T2DM (HR, 1.76; 95% CI, 1.12-2.77; P = .014), and history of CVA (HR, 1.76; 95% CI, 1.04-2.98; P = .04) were significantly associated with an increased risk of mortality. Older age and T2DM were independently associated with decreased primary (HR, 1.03; 95% CI, 1.02-1.04; P < .01, HR, 1.69; 95% CI, 1.22-2.33; P < .01, respectively) and secondary (HR, 1.03; 95% CI, 1.01-1.04; P < .01, HR, 2.07; 95% CI, 1.42-3.00; P < .01, respectively) AVF patency during follow-up.Compared with patients in the non-DM group, patients in the T2DM group had a higher mortality rate and worse AVF patency rates.
本研究比较了患有和未患有2型糖尿病（T2DM）的初治血液透析患者的生存临床结局及动静脉内瘘（AVF）通畅情况。在2011年1月至2013年12月期间，384例连续的、确诊首次上肢AVF置入的初治血液透析患者被分为T2DM组（n = 180，46.9%）和非糖尿病组（n = 204，53.1%），并进行回顾性分析。主要结局是全因死亡率，次要结局是AVF通畅情况。T2DM组患者的高血压患病率（P = 0.02）、吸烟率（P < 0.01）、心血管疾病患病率（P < 0.01）、脑血管意外（CVA）病史（P < 0.01）和外周动脉闭塞性疾病患病率（P < 0.01）均高于非糖尿病组。在Kaplan-Meier生存分析中，非糖尿病组的总生存率和AVF通畅率显著高于T2DM组（P均< 0.01）。在调整模型中，年龄较大（风险比[HR]，1.04；95%置信区间[CI]，1.02 - 1.06；P < 0.01）、T2DM（HR，1.76；95% CI，1.12 - 2.77；P = 0.014）和CVA病史（HR，1.76；95% CI，1.04 - 2.98；P = 0.04）与死亡风险增加显著相关。年龄较大和T2DM分别与随访期间原发性（HR，1.03；95% CI，1.02 - 1.04；P < 0.01，HR，1.69；95% CI，1.22 - 2.33；P < 0.01）和继发性（HR，1.03；95% CI，1.01 - 1.04；P < 0.01，HR，2.07；95% CI，1.42 - 3.00；P < 0.01）AVF通畅情况降低独立相关。与非糖尿病组患者相比，T2DM组患者的死亡率更高，AVF通畅率更差。
