Hung Tung-Wei, Wu Sheng-Wen, Chiou Jeng-Yuan, Wang Yu-Hsun, Liao Yu-Chan, Wei Cheng-Chung
School of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan.
Institute of Medicine, Chung Shan Medical University, Taichung 402306, Taiwan.
J Pers Med. 2022 Apr 8;12(4):598. doi: 10.3390/jpm12040598.
A functional permanent vascular access (VA) is required to perform a successful hemodialysis procedure. Hemodialysis VA dysfunction is a major cause of morbidity and hospitalization in the hemodialysis population. Cardiovascular disease (CVD) is the leading cause of death in patients receiving chronic hemodialysis. Information about CVD associated with hemodialysis VA dysfunction is unclear. We analyzed the association between dialysis VA dysfunction and the risk of developing CVD in hemodialysis patients. This nationwide population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan. One million subjects were sampled from 23 million beneficiaries and data was collected from 2000 to 2013. Patients with end-stage renal disease who had received permanent VA construction and hemodialysis and were aged at least 20 years old from 2000 to 2007 were included in the study population. The primary outcome was CVD, as defined by ICD-9-CM codes 410-414 and 430-437. A total of 197 individuals with permanent VA dysfunction were selected as the test group, and 100 individuals with non-permanent VA dysfunction were selected as the control group. Compared with the control group, the adjusted hazard ratio of CVD for the VA dysfunction group was 3.05 (95% CI: 1.14-8.20). A Kaplan-Meier analysis revealed that the cumulative incidence of CVD was higher in the permanent VA dysfunction group than in the comparison group. Permanent VA dysfunction is significantly associated with an increased risk of subsequent CVD.
成功进行血液透析需要一个功能性的永久性血管通路（VA）。血液透析VA功能障碍是血液透析人群发病和住院的主要原因。心血管疾病（CVD）是接受慢性血液透析患者的主要死因。关于与血液透析VA功能障碍相关的CVD信息尚不清楚。我们分析了透析VA功能障碍与血液透析患者发生CVD风险之间的关联。这项基于全国人群的队列研究使用了台湾国民健康保险研究数据库的数据。从2300万受益人中抽取了100万受试者，并收集了2000年至2013年的数据。研究人群包括2000年至2007年接受永久性VA构建和血液透析且年龄至少20岁的终末期肾病患者。主要结局是CVD，由ICD-9-CM编码410-414和430-437定义。总共选择了197名永久性VA功能障碍个体作为试验组，100名非永久性VA功能障碍个体作为对照组。与对照组相比，VA功能障碍组CVD的调整后风险比为3.05（95%CI：1.14-8.20）。Kaplan-Meier分析显示，永久性VA功能障碍组CVD的累积发病率高于比较组。永久性VA功能障碍与随后发生CVD的风险增加显著相关。
