Division of Nephrology and Hypertension, Ben Carson (Snr) School of Medicine, Babcock University Teaching Hospital, IlishanRemo, Ogun State, Nigeria. Email:
Tristate Heart and Vascular Centre, Ben Carson (Snr) School of Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria.
West Afr J Med. 2023 Apr 28;40(4):421-427.
Dialysis vascular access has remained a major determinant of intra and inter-dialytic events and the dialysis dose, and this impacts the quality of life, morbidity and mortality of dialysis patients. Assessing the different access types would help minimize peri-dialytic events and improve outcome.
This was a retrospective, age and sex-matched, comparative study that assessed dialysis sessions with tunneled dialysis catheters (TDCs) with arteriovenous fistula (AVF).
Two hundred and four participants with 1062 sessions were involved. The male participants had 66.7% of all sessions, 60.6% of sessions with TDCs and 87.3% of sessions with AVF, P=0.001. The elderly constituted 23.5% of all participants but 37.7% of sessions with AVF, P=0.04. The percentage of the health-insured was more in sessions with AVF compared to the study population, P<0.001. Diabetics were more likely to use the TDCs, P=0.06. Participants using AVF were more likely to receive full dialysis and erythropoietin treatment, P<0.001. Intradialytic hypotension and dialysis termination were commoner with AVF than TDCs, P=0.03 and P=0.04 respectively. The dialysis dose was higher with AVF than TDCs, P=0.02. Predictors of AVF as dialysis access were male gender, advancing age, health insurance and full treatment compliance.
There is predominance of venous catheters in our dialysis population. The AVF gave better BP control, fluid and solute clearance, and dialysis dose, and was commoner with males, the health insured and older participants. Intradialytic hypotension was commoner with AVF as IDHT was commoner with TDCs.
透析血管通路仍然是影响透析患者内、透析间事件和透析剂量以及生活质量、发病率和死亡率的主要决定因素。评估不同的通路类型有助于最大限度地减少透析期间的事件并改善结果。
这是一项回顾性、年龄和性别匹配的比较研究，评估了隧道透析导管（TDC）与动静脉瘘（AVF）的透析疗程。
共有 204 名参与者，涉及 1062 次透析疗程。男性参与者占所有疗程的 66.7%，TDC 疗程的 60.6%和 AVF 疗程的 87.3%，P=0.001。老年人占所有参与者的 23.5%，但 AVF 疗程的占比为 37.7%，P=0.04。AVF 疗程的医疗保险参保率高于研究人群，P<0.001。糖尿病患者更有可能使用 TDC，P=0.06。使用 AVF 的参与者更有可能接受充分的透析和促红细胞生成素治疗，P<0.001。与 TDC 相比，AVF 更常见的是透析期间低血压和透析终止，P=0.03 和 P=0.04。AVF 的透析剂量高于 TDC，P=0.02。AVF 作为透析通路的预测因素是男性、年龄增长、医疗保险和充分治疗依从性。
在我们的透析人群中，静脉导管占主导地位。AVF 可更好地控制血压、清除液体和溶质，以及提供更高的透析剂量，且更常见于男性、医疗保险参保者和年龄较大的参与者。与 TDC 相比，AVF 更常见透析期间低血压，而与 TDC 相比，AVF 更常见透析终止。
