Tunis Med. 2021;99(5):575-581.
Arterio-venous fistula (AVF) is the first-choice vascular access for hemodialysis (HD). Hemodialysis catheter (KT) may be a temporary or permanent alternative.
To evaluate indications of KT and AVF and their predictive factors of complications.
It's a retrospective multicentric study interesting KT and AVF in patients treated by hemodialysis, in the Kef Governorate in north-western Tunisia, during the period from 01/07/18 to 31/12/18.
We included 288 AVF and 148 KT that were created on 205 patients. The average age was 58.14 years, the sex ratio was 1.5. Hypertensive patients and diabetics represented respectively 83.9% and 27.3% of the population. Diabetic nephropathy was the most common (25.9%). For the KT, the main indication was the wait for AVF creation (68.9%). The overall incidence of immediate complications was 11.5%. Dysfunction was reported in 23.6% of cases with obesity and tunneled type of KT as contributing factors. KT infection was occuring in 39.2% of cases. It was promoted by prolonged duration of use and hemoglobin level < 8g/dl. The use of antiseptic lock reduced infections' risk (p=0.011). For AVF, the most common complications were thrombosis (36.2%), aneurysm (29.9%) and stenosis (22.6%). Survival rate was 60% at 2000 days. The AVF impairing factors were diabetes (p=0.05), obesity (p=0.05), anterior AVF creation (p=0.011), AVF grafts (p=0.016), and anticoagulant therapy (p=0.0001). Antiplatelet therapy improved AVF patency (p=0.02).
Much remained to be done to reduce KT complications, creation of AVF on time and prevention of their complications.
动静脉瘘（AVF）是血液透析（HD）的首选血管通路。血液透析导管（KT）可能是一种临时或永久的替代方法。
评估 KT 和 AVF 的适应证及其并发症的预测因素。
这是一项回顾性多中心研究，涉及 2018 年 7 月 1 日至 12 月 31 日在突尼斯西北部凯夫省接受血液透析治疗的患者的 KT 和 AVF。
我们纳入了 288 个 AVF 和 148 个 KT，这些 KT 和 AVF 是在 205 名患者身上创建的。平均年龄为 58.14 岁，性别比为 1.5。高血压和糖尿病患者分别占人群的 83.9%和 27.3%。糖尿病肾病是最常见的（25.9%）。对于 KT，主要适应证是等待 AVF 创建（68.9%）。总的即时并发症发生率为 11.5%。功能障碍的发生与肥胖和隧道型 KT 有关，其发生率为 23.6%。KT 感染发生率为 39.2%。延长使用时间和血红蛋白水平<8g/dl 会促进感染。使用抗菌锁可降低感染风险（p=0.011）。对于 AVF，最常见的并发症是血栓形成（36.2%）、动脉瘤（29.9%）和狭窄（22.6%）。2000 天时的生存率为 60%。影响 AVF 的因素是糖尿病（p=0.05）、肥胖（p=0.05）、前 AVF 构建（p=0.011）、AVF 移植物（p=0.016）和抗凝治疗（p=0.0001）。抗血小板治疗可改善 AVF 通畅率（p=0.02）。
仍需努力减少 KT 并发症、及时创建 AVF 并预防其并发症。
