Department of Medicine, University of Melbourne, Melbourne, Australia.
Department of Nephrology, Austin Health, Austin Hospital, 145 Studley Road, Heidelberg, VIC, 3084, Australia.
J Nephrol. 2021 Feb;34(1):89-95. doi: 10.1007/s40620-020-00834-w. Epub 2020 Aug 27.
Transitions from peritoneal dialysis (PD) to haemodialysis (HD) are often unpredictable and central venous catheters (CVCs) are frequently required. Early studies found few back-up arteriovenous fistulas (bAVFs) were ever used. The PD population's characteristics have changed over time which may have altered the likelihood of bAVFs being used. This study aimed to report use of, and outcomes associated with, bAVFs in a contemporary cohort of peritoneal dialysis patients.
A single-centre, retrospective study of PD patients commencing dialysis between 2006-2016, stratified according to presence/absence of bAVF.
One hundred seventy-six patients were included-82 with bAVF, 94 without bAVF-of whom 156 transitioned off PD. Transitions were to HD (49%), transplantation (23%), death (15%) and renal-recovery (1%). 51% of bAVFs were successfully used and 82% of bAVFs were patent when required. Median time from creation to bAVF use was 2.5 years. More patients with a bAVF transitioned to HD (62 vs 38%, p < 0.005). However, CVC requirement at the time of transition to HD was much less common in the bAVF group (18 vs 83%, p < 0.0001), such that the overall risk of requiring a CVC was significantly lower in the bAVF group (11 vs 31%, p < 0.005). Rates of returning to PD amongst patients who transitioned to HD with a CVC or an AVF were similar (19 vs 26%, p = 0.16).
In this cohort of PD patients, utilisation of back-up arteriovenous fistulas was higher than previously reported, and presence of a back-up arteriovenous fistula was associated with a lower rate of future CVC use.
从腹膜透析（PD）过渡到血液透析（HD）通常是不可预测的，经常需要中心静脉导管（CVC）。早期的研究发现，很少有备用动静脉瘘（bAVF）被使用。随着时间的推移，PD 患者的特征发生了变化，这可能改变了使用 bAVF 的可能性。本研究旨在报告在一个当代 PD 患者队列中，使用和与 bAVF 相关的结果。
一项单中心、回顾性研究，纳入了 2006 年至 2016 年间开始透析的 PD 患者，根据是否存在 bAVF 进行分层。
共纳入 176 名患者，其中 82 名患者有 bAVF，94 名患者无 bAVF，其中 156 名患者从 PD 过渡。过渡的方式包括 HD（49%）、移植（23%）、死亡（15%）和肾功能恢复（1%）。51%的 bAVF 被成功使用，82%的 bAVF 在需要时是通畅的。从创建到 bAVF 使用的中位时间为 2.5 年。更多有 bAVF 的患者转至 HD（62%比 38%，p<0.005）。然而，bAVF 组在转至 HD 时需要 CVC 的情况要少得多（18%比 83%，p<0.0001），因此 bAVF 组总体需要 CVC 的风险明显较低（11%比 31%，p<0.005）。在转至 HD 并使用 CVC 或 AVF 的患者中，返回 PD 的比例相似（19%比 26%，p=0.16）。
在本队列的 PD 患者中，备用动静脉瘘的使用率高于以往报告，存在备用动静脉瘘与未来 CVC 使用率降低有关。
