Celik Serhat, Gok Oguz Ebru, Ulusal Okyay Gulay, Selen Tamer, Ayli Mehmet Deniz
Department of Internal Medicine, University of Health Sciences, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey.
Department of Nephrology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey.
Int J Artif Organs. 2021 Apr;44(4):229-236. doi: 10.1177/0391398820952808. Epub 2020 Sep 22.
BACKGROUND/AIM: Hemodialysis is the most used renal replacement therapy option for patients with end-stage renal disease. Arteriovenous fistulas (AVFs) and tunnel-cuffed venous catheters (tCVC) are commonly used vascular access routes and have advantages and disadvantages compared to each other. This study focuses on the effects of AVFs and tCVCs on morbidity and mortality in hemodialysis patients.
The records (between January 2015 and January 2017) of 110 patients (55 patients with AVF and 55 patients with tCVC) under hemodialysis therapy for at least 6 months were evaluated retrospectively. The data about blood tests, hospitalizations, and mortality were compared between patients with AVF and tCVC.
Fifty-five patients (25 male, 58 ± 14 years old) were undergoing hemodialysis via AVF. Fifty-five patients (17 male, 63 ± 14 years old) were undergoing hemodialysis via tunneled CVCs. Thirty (54.5%) of the hospitalization patients had AVF and 46 (83.6%) had CVCs ( < 0.01). The only independent predictor of hospitalization was the use of tCVC as vascular access, according to multivariate regression analysis ( = 0.01). Seven (30%) of the dead patients had AVF and 16 (69.6%) had CVCs ( = 0.035). Use of tCVC appeared to be a mortality predictor in univariate regression analysis ( = 0.039). But the significance did not continue in multivariate model ( = 0.578) in which the duration of hemodialysis appeared as the only significant factor ( = 0.002).
Patients undergoing hemodialysis via AVF had fewer all-cause hospitalizations and mortality rate than those using tunneled CVCs.
背景/目的：血液透析是终末期肾病患者最常用的肾脏替代治疗选择。动静脉内瘘（AVF）和带隧道涤纶套中心静脉导管（tCVC）是常用的血管通路，两者各有优缺点。本研究聚焦于AVF和tCVC对血液透析患者发病率和死亡率的影响。
回顾性评估110例接受血液透析治疗至少6个月的患者（2015年1月至2017年1月）的记录（55例使用AVF，55例使用tCVC）。比较AVF和tCVC患者的血液检查、住院和死亡数据。
55例患者（25例男性，58±14岁）通过AVF进行血液透析。55例患者（17例男性，63±14岁）通过带隧道涤纶套中心静脉导管进行血液透析。住院患者中30例（54.5%）使用AVF，46例（83.6%）使用中心静脉导管（P<0.01）。根据多因素回归分析，住院的唯一独立预测因素是使用tCVC作为血管通路（P=0.01）。死亡患者中7例（30%）使用AVF，16例（69.6%）使用中心静脉导管（P=0.035）。在单因素回归分析中，使用tCVC似乎是死亡率的预测因素（P=0.039）。但在多因素模型中该显著性未持续存在（P=0.578），其中血液透析时长是唯一显著因素（P=0.002）。
通过AVF进行血液透析的患者全因住院率和死亡率低于使用带隧道涤纶套中心静脉导管的患者。
