Raksasuk Sukit, Chaisathaphol Thanet, Kositamongkol Chayanis, Chokvanich Wittawat, Pumuthaivirat Pratya, Srithongkul Thatsaphan
Division of Nephrology, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
Division of Ambulatory Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand.
Ann Med Surg (Lond). 2020 Oct 21;60:76-80. doi: 10.1016/j.amsu.2020.10.032. eCollection 2020 Dec.
There is currently a controversy for the optimal vascular access option in the elderly, regarding their multiple comorbidities and life expectancies. Our study aimed to compare the survival of tunneled cuff venous catheter (CVC) and arteriovenous access (AV access) in elderly patients.
A retrospective cohort study was performed by electronic medical record review. All hemodialysis patients aged 65 years and over who firstly initiated dialysis from January 1, 2012 to December 31, 2016 at Siriraj hospital, Thailand, were included. The primary outcomes are to compare a 2-year period of survival between CVC and AV access in terms of abandonment, death, and combined outcome. Propensity score covariate and Charlson Comorbidity Score (CCI) were used for multivariable analysis adjustment.
A total of 359 patients were included; 216 (60.2%) patients had initiated hemodialysis via CVC while the rest used AV access. The patients' average ages were 76.7 ± 7.0 and 74.0 ± 5.8 years (p-value<0.001) in the CVC and AV access group, respectively. The 2-year mortality rates of CVC and AV access groups were 24.1% and 15.4%, respectively (p-value = 0.038). Multivariable analyses showed that the adjusted hazard ratio (aHR) of combined endpoints, i.e., vascular access abandonment and death, was statistically different only in the CCI-adjusted model (aHR = 0.68, 95% CI: 0.46-0.99). Mortality from infection cause was more common in the CVC group than the AV access group.
CVC access maybe considers an alternative option for frail elderly patients. However, the patient selection is a crucial issue, given higher infection-related mortality in patients using CVC.
鉴于老年人存在多种合并症和预期寿命情况，目前对于老年患者最佳的血管通路选择存在争议。我们的研究旨在比较老年患者隧道式带 cuff 静脉导管（CVC）和动静脉通路（AV 通路）的生存率。
通过电子病历回顾进行一项回顾性队列研究。纳入了 2012 年 1 月 1 日至 2016 年 12 月 31 日在泰国诗里拉吉医院首次开始透析的所有 65 岁及以上的血液透析患者。主要结局是比较 CVC 和 AV 通路在 2 年期间在通路废弃、死亡及综合结局方面的生存率。倾向评分协变量和 Charlson 合并症评分（CCI）用于多变量分析调整。
共纳入 359 例患者；216 例（60.2%）患者通过 CVC 开始血液透析，其余患者使用 AV 通路。CVC 组和 AV 通路组患者的平均年龄分别为 76.7±7.0 岁和 74.0±5.8 岁（p 值<0.001）。CVC 组和 AV 通路组的 2 年死亡率分别为 24.1%和 15.4%（p 值 = 0.038）。多变量分析显示，综合终点（即血管通路废弃和死亡）的调整后风险比（aHR）仅在 CCI 调整模型中有统计学差异（aHR = 0.68，95%CI：0.46 - 0.99）。CVC 组因感染导致的死亡率比 AV 通路组更常见。
对于体弱的老年患者，CVC 通路可被视为一种替代选择。然而，鉴于使用 CVC 的患者感染相关死亡率较高，患者选择是一个关键问题。
