Li Jia, Lu Hua, Xie Zhen, Li Qingchao, Shi Hongguang
Department of Nephrology, Navy 971 Hospital, Qingdao, Shandong 266000, P.R. China.
Exp Ther Med. 2023 Jul 6;26(2):399. doi: 10.3892/etm.2023.12098. eCollection 2023 Aug.
The impact of the type of vascular access on the outcomes in the elderly haemodialysis patients is still unclear. The goal of the present study was to compare survival outcomes in elderly haemodialysis patients who received either arteriovenous graft (AVG) or arteriovenous fistula (AVF). A systematic literature search was performed in EMBASE, Cochrane, MEDLINE, ScienceDirect and Google Scholar databases for papers published from January 1954 until January 2022. Risk of bias in the selected publications was assessed by Newcastle Ottawa scale or Cochrane risk of bias tool depending on the study design. Meta-analysis was carried out using the random-effects model. Data were reported as pooled odds ratio (OR) or hazard ratio (HR) with 95% confidence interval (CI). A total of 12 studies were included in the analysis. The majority of the studies had poor quality. Elderly patients receiving AVG had significantly worse survival rate compared with patients that received AVF for the haemodialysis access, with a pooled HR of 1.38 (95% CI, 1.24-1.53; I=79.9%). Pooled HR for access survival was 1.60 (95% CI, 1.54-1.66; I=0%). Pooled OR for primary patency rate, maturation failure and infections were 1.81 (95% CI, 0.73-4.49; I=79.2%), 0.33 (95% CI, 0.12-0.91; I=70.4%) and 9.74 (95% CI, 2.60-36.49; I=52.4%), respectively. These results suggested that in elderly patients undergoing haemodialysis, AVG was associated with reduced overall survival and access survival, and higher infection rate, compared with AVF. Notably, AVG was also associated with a lower risk of maturation failure, presenting a potential advantage in specific patient populations (study registration: PROSPERO, no. CRD42022313199).
血管通路类型对老年血液透析患者预后的影响尚不清楚。本研究的目的是比较接受动静脉移植物（AVG）或动静脉内瘘（AVF）的老年血液透析患者的生存结局。在EMBASE、Cochrane、MEDLINE、ScienceDirect和谷歌学术数据库中进行了系统的文献检索，以查找1954年1月至2022年1月发表的论文。根据研究设计，使用纽卡斯尔渥太华量表或Cochrane偏倚风险工具评估所选出版物的偏倚风险。采用随机效应模型进行荟萃分析。数据以合并比值比（OR）或风险比（HR）及95%置信区间（CI）报告。分析共纳入12项研究。大多数研究质量较差。接受AVG的老年患者与接受AVF作为血液透析通路的患者相比，生存率显著更差，合并HR为1.38（95%CI，1.24 - 1.53；I = 79.9%）。通路生存的合并HR为1.60（95%CI，1.54 - 1.66；I = 0%）。原发性通畅率、成熟失败和感染的合并OR分别为1.81（95%CI，0.73 - 4.49；I = 79.2%）、0.33（95%CI，0.12 - 0.91；I = 70.4%）和9.74（95%CI，2.60 - 36.49；I = 52.4%）。这些结果表明，在接受血液透析的老年患者中，与AVF相比，AVG与总体生存率和通路生存率降低以及感染率升高相关。值得注意的是，AVG还与较低的成熟失败风险相关，在特定患者群体中具有潜在优势（研究注册号：PROSPERO，编号CRD42022313199）。
