Kidney Research Laboratory, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China.
National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, China.
Int J Artif Organs. 2021 May;44(5):302-309. doi: 10.1177/0391398820962112. Epub 2020 Oct 4.
Examine the impacts of age, diabetes, gender, and access type on vascular access (VA) associated costs among Chinese hemodialysis (HD) patients.
We retrospectively included patients whose first permanent VA was created at the West China Hospital. Clinical characteristics, maturation, intervention, utilization, and exchange of every VA, as well as VA-related infection were collected. The study period for each patient was from HD initiation to the last follow-up. VA-related costs, including those for placement and intervention procedures, were calculated according to the standards set in 2019 for Chinese tertiary hospitals. U and Chi-square tests were conducted for comparisons between groups.
A total of 358 Chinese HD patients experienced functionally 143 arteriovenous fistula (AVF), 22 arteriovenous graft (AVG), and 439 tunneled cuffed central venous catheter (tcCVC) during a median study period of 26 (IQR 13-44) months, of which 42.5% used more than one permanent VA. The median annual VA-related cost in the groups of age >75 years and ⩽75 years, diabetes and non-diabetes, male and female, was $525 and $397 ( = 0.016), $459 and $462 ( = 0.64), $476 and $445 ( = 0.94), respectively. The median monthly costs for AVF ($18), AVG ($289), and tcCVC ($37) were significantly different.
HD patients aged >75 years had significantly higher annual VA-related costs. However, the annual VA-related costs did not differ across the diabetes groups or the gender groups. AVF was the most cost-effective permanent VA type in China, partly due to the inexpensive materials used compared to AVG or tcCVC.
探讨中国血液透析（HD）患者血管通路（VA）相关成本的年龄、糖尿病、性别和通路类型的影响。
我们回顾性纳入了在华西医院建立第一例永久性 VA 的患者。收集了每位患者 VA 的临床特征、成熟、干预、利用和交换以及 VA 相关感染。每位患者的研究期为 HD 起始至最后一次随访。根据 2019 年中国三级医院标准，计算 VA 相关成本，包括置管和介入手术费用。采用 U 检验和卡方检验进行组间比较。
共纳入 358 例中国 HD 患者，在中位 26（IQR 13-44）个月的研究期间，经历了 143 例功能性动静脉瘘（AVF）、22 例动静脉移植物（AVG）和 439 例隧道带袖中央静脉导管（tcCVC），其中 42.5%的患者使用了不止一种永久性 VA。年龄>75 岁和⩽75 岁、糖尿病和非糖尿病、男性和女性患者的 VA 相关年度费用中位数分别为 525 美元和 397 美元（P=0.016）、459 美元和 462 美元（P=0.64）、476 美元和 445 美元（P=0.94）。AVF（18 美元）、AVG（289 美元）和 tcCVC（37 美元）的月费用中位数差异有统计学意义。
年龄>75 岁的 HD 患者 VA 相关年度费用显著较高。然而，糖尿病组或性别组之间的 VA 相关年度费用没有差异。AVF 是中国最具成本效益的永久性 VA 类型，部分原因是与 AVG 或 tcCVC 相比，其使用的材料较为便宜。
