Hudson Rebecca, Pascoe Elaine M, See Yong Pey, Cho Yeoungjee, Polkinghorne Kevan R, Paul-Brent Peta-Anne, Hooi Lai-Seong, Ong Loke-Meng, Mori Trevor A, Badve Sunil V, Cass Alan, Kerr Peter G, Voss David, Hawley Carmel M, Johnson David W, Irish Ashley B, Viecelli Andrea K
Department of Nephrology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
Australasian Kidney Trials Network, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
J Vasc Access. 2024 Jan;25(1):193-202. doi: 10.1177/11297298221099134. Epub 2022 Jun 10.
To describe and compare de novo arteriovenous fistula (AVF) failure rates between Australia and New Zealand (ANZ), and Malaysia.
AVFs are preferred for haemodialysis access but are limited by high rates of early failure.
A post hoc analysis of 353 participants from ANZ and Malaysia included in the FAVOURED randomised-controlled trial undergoing de novo AVF surgery was performed. Composite AVF failure (thrombosis, abandonment, cannulation failure) and its individual components were compared between ANZ ( = 209) and Malaysian ( = 144) participants using logistic regression adjusted for patient- and potentially modifiable clinical factors.
Participants' mean age was 55 ± 14.3 years and 64% were male. Compared with ANZ participants, Malaysian participants were younger with lower body mass index, higher prevalence of diabetes mellitus and lower prevalence of cardiovascular disease. AVF failure was less frequent in the Malaysian cohort (38% vs 54%; adjusted odds ratio (OR) 0.53, 95% confidence interval (CI) 0.31-0.93). This difference was driven by lower odds of cannulation failure (29% vs 47%, OR 0.45, 95% CI 0.25-0.80), while the odds of AVF thrombosis (17% vs 20%, OR 1.24, 95% CI 0.62-2.48) and abandonment (25% vs 23%, OR 1.17, 95% CI 0.62-2.16) were similar.
The risk of AVF failure was significantly lower in Malaysia compared to ANZ and driven by a lower risk of cannulation failure. Differences in practice patterns, including patient selection, surgical techniques, anaesthesia or cannulation techniques may account for regional outcome differences and warrant further investigation.
描述并比较澳大利亚和新西兰（澳新地区）与马来西亚初次动静脉内瘘（AVF）的失败率。
AVF是血液透析通路的首选，但受早期高失败率限制。
对纳入FAVOURED随机对照试验的353名来自澳新地区和马来西亚的参与者进行事后分析，这些参与者均接受了初次AVF手术。使用经患者和潜在可改变临床因素调整的逻辑回归，比较澳新地区（n = 209）和马来西亚（n = 144）参与者的复合AVF失败（血栓形成、废弃、插管失败）及其各个组成部分。
参与者的平均年龄为55±14.3岁，64%为男性。与澳新地区参与者相比，马来西亚参与者更年轻，体重指数更低，糖尿病患病率更高，心血管疾病患病率更低。马来西亚队列中AVF失败的发生率较低（38%对54%；调整后的优势比（OR）为0.53，95%置信区间（CI）为0.31 - 0.93）。这种差异是由插管失败几率较低所致（29%对47%，OR为0.45，95%CI为0.25 - 0.80），而AVF血栓形成几率（17%对20%，OR为1.24，95%CI为0.62 - 2.48）和废弃几率（25%对23%，OR为1.17，95%CI为0.62 - 2.16）相似。
与澳新地区相比，马来西亚AVF失败的风险显著更低，且由较低的插管失败风险所致。包括患者选择、手术技术、麻醉或插管技术在内的实践模式差异可能导致了地区性结果差异，值得进一步研究。
