Wei Suijiao, Jiao Jing, Yu Yan, Tian Xiujuan, Yang Xiaoxia, Feng Shidong, Li Yajuan, Zhang Peng, Bai Ming
The Department of Nephrology, Xijing Hospital, the Fourth Military Medical University, Xi'an, Shaanxi, China.
Xi'an Medical University, Xi'an, Shaanxi, China.
Int J Artif Organs. 2023 Apr;46(4):195-201. doi: 10.1177/03913988231162384. Epub 2023 Mar 21.
Maintenance hemodialysis (MHD) patients are often admitted to the hospital for severe morbidities. Prolonged intermittent renal replacement therapy (PIRRT) is required during the hospital staying. There are controversial opinions on the use of arteriovenous fistula (AVF) as vascular access for PIRRT in MHD patients.
Patients with AVF who accepted PIRRT in our center between January 2014 and June 2021 were retrospectively screened. AVF dysfunction and patient mortality were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of AVF dysfunction.
About 162 patients were included in our present study. Twenty-six experienced AVF dysfunction, of whom 53.8%, 19.2%, and 27.0% had percutaneous transluminal balloon angioplasty, surgical revision, and AVF reconstruction, respectively. The accumulated AVF dysfunction rates were 11.8%, 16.2%, and 21.0% in 1, 2, and 3 years, respectively. Multivariate analysis revealed that smoking (HR 2.750, 95% CI 1.181-6.402, = 0.019), higher platelet (PLT, HR 1.009, 95% CI 1.000-1.017, = 0.047), higher prothrombin activity (PTA, HR 1.039, 95% CI 1.012-1.066, = 0.004), and lower diastolic blood pressure (DBP, HR 0.963, 95% CI 0.932-0.996, = 0.026) were independent risk factors for AVF dysfunction. During the follow-up period, 37 patients died.
Overall, the use of AVF for PIRRT might not dramatically increase the incidence of AVF dysfunction. And, Smoking, lower DBP, higher PLT, and higher PTA were associated with increased AVF dysfunction.
维持性血液透析（MHD）患者常因严重疾病入院。住院期间需要进行延长的间歇性肾脏替代治疗（PIRRT）。对于动静脉内瘘（AVF）作为MHD患者PIRRT的血管通路的使用存在争议。
回顾性筛选2014年1月至2021年6月在本中心接受PIRRT的AVF患者。评估AVF功能障碍和患者死亡率作为终点。采用单因素和多因素回归模型确定AVF功能障碍的危险因素。
本研究共纳入约162例患者。26例出现AVF功能障碍，其中分别有53.8%、19.2%和27.0%的患者接受了经皮腔内球囊血管成形术、手术修复和AVF重建。1年、2年和3年的累积AVF功能障碍发生率分别为11.8%、16.2%和21.0%。多因素分析显示，吸烟（HR 2.750，95%CI 1.181 - 6.402，P = 0.019）、较高的血小板计数（PLT，HR 1.009，95%CI 1.000 - 1.017，P = 0.047）、较高的凝血酶原活性（PTA，HR 1.039，95%CI 1.012 - 1.066，P = 0.004）以及较低的舒张压（DBP，HR 0.963，95%CI 0.932 - 0.996，P = 0.026）是AVF功能障碍的独立危险因素。随访期间，37例患者死亡。
总体而言，将AVF用于PIRRT可能不会显著增加AVF功能障碍的发生率。并且，吸烟、较低的DBP、较高的PLT和较高的PTA与AVF功能障碍增加有关。
