糖尿病、教育水平和护理依赖与慢性肾脏病患者使用临时血管通路的关系。

Association of diabetes, education level, and care dependency with use of temporary vascular access in patients with chronic kidney disease.

机构信息

Division of Nephrology, Asia University Hospital, Taichung, Taiwan.

Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan.

出版信息

Semin Dial. 2021 Mar;34(2):130-136. doi: 10.1111/sdi.12930. Epub 2020 Oct 26.

DOI:10.1111/sdi.12930

PMID:33103809

Abstract

OBJECTIVE

Temporary vascular access (TVA) is frequently used during the first dialysis in patients with chronic kidney disease (CKD), and it is associated with an increased risk of infection, central vein stenosis, and mortality. Here, factors associated with TVA in patients with CKD were explored.

METHODS

This study included patients in a single-center CKD care program who initiated long-term renal replacement therapy. The primary outcome was TVA use at first dialysis. Factors possibly associated with TVA use were analyzed using Cox regression.

RESULTS

Temporary vascular access was used in 53.2% of the patients at first dialysis. In total, 73.2% (n = 865) and 26.8% (n = 317) of the patients were on hemodialysis and peritoneal dialysis, respectively. Multivariate Cox regression analysis showed that TVA use in patients with CKD was associated with diabetes (hazard ratio [HR] 1.52, 95% confidence interval [CI] 1.28-1.81, p < 0.001), lower albumin (HR 0.82, 95% CI 0.75-0.91, p < 0.001), lower education level (HR 0.75, 95% CI 0.56-1.00, p = 0.055), and total care dependency (HR 1.92, CI 1.44-3.43, p = 0.003).

CONCLUSION

Diabetes, education level, and care dependency are associated with TVA at dialysis initiation in patients with CKD.

摘要

目的

在慢性肾脏病（CKD）患者的首次透析中，常使用临时血管通路（TVA），这与感染、中心静脉狭窄和死亡率增加有关。本研究旨在探讨 CKD 患者中与 TVA 相关的因素。

方法

本研究纳入了在单中心 CKD 护理项目中开始长期肾脏替代治疗的患者。主要结局为首次透析时使用 TVA。使用 Cox 回归分析可能与 TVA 使用相关的因素。

结果

53.2%的患者在首次透析时使用了临时血管通路。共有 73.2%（n=865）和 26.8%（n=317）的患者分别接受血液透析和腹膜透析。多变量 Cox 回归分析显示，CKD 患者使用 TVA 与糖尿病（危险比 [HR] 1.52，95%置信区间 [CI] 1.28-1.81，p<0.001）、低白蛋白（HR 0.82，95%CI 0.75-0.91，p<0.001）、低教育水平（HR 0.75，95%CI 0.56-1.00，p=0.055）和完全依赖护理（HR 1.92，CI 1.44-3.43，p=0.003）相关。