Department of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Medical Sciences Renal Medicine, Uppsala University, Uppsala, Sweden.
Kidney360. 2024 Jun 1;5(6):877-885. doi: 10.34067/KID.0000000000000453. Epub 2024 May 1.
More patients with autosomal dominant polycystic kidney disease received their first intervention to re-establish vascular access patency. Patients with autosomal dominant polycystic kidney disease do not require differential monitoring and treatment of hemodialysis vascular access.
Autosomal dominant polycystic kidney disease (ADPKD) is a leading hereditary cause of ESKD, often using hemodialysis as a form of RRT. Patients with ADPKD may also present with extrarenal manifestations, including arterial aneurysms. The gold standard for hemodialysis access is an arteriovenous vascular access (VA), such as arteriovenous fistulas (AVFs) or arteriovenous grafts (AVGs). However, limitations, such as low VA flow and inadequate AVF outward remodeling, affect VA utilization. This study aimed to explore whether ADPKD affects patency rates of AVFs/AVGs in comparison with other underlying ESKD causes.
We conducted a retrospective cohort study using data from the Swedish Renal Registry from 2011 to 2020, with follow-up until 2022. We included 496 patients with ADPKD and 4321 propensity score–matched controls. VA patency rates of patients with ADPKD were compared with those of non-ADPKD patients using Kaplan–Meier survival curves and Mantel–Cox log-rank test. Interventions to maintain or restore patency were also analyzed.
Patients with ADPKD constituted 8.0% of all patients, with a higher proportion in the pre-ESKD phase during VA creation (51.6% versus 40.6%). No significant differences were observed in primary, postcannulation primary, secondary, or functional patency between patients with ADPKD and non-ADPKD patients. However, more VAs were ligated in patients with ADPKD (10.5% versus 7.7%, = 0.03), and they underwent more first interventions to re-establish flow (49.4% versus 41.9%, = 0.02).
These findings suggest that AVF/AVG patency remains comparable in patients with ESKD with or without ADPKD, and VA monitoring and treatment strategies for patients with ADPKD should align with those for individuals with other ESKD causes.
更多常染色体显性遗传多囊肾病患者接受了首次干预以恢复血管通路通畅。常染色体显性遗传多囊肾病患者无需对血液透析血管通路进行差异化监测和治疗。
常染色体显性遗传多囊肾病（ADPKD）是导致终末期肾病（ESKD）的主要遗传性病因之一，常采用血液透析作为肾脏替代治疗（RRT）的一种方式。ADPKD 患者还可能出现肾脏外表现，包括动脉动脉瘤。血液透析通路的金标准是动静脉血管通路（VA），如动静脉瘘（AVF）或动静脉移植物（AVG）。然而，VA 利用受到限制，如 VA 流量低和 AVF 向外重塑不足等。本研究旨在探讨与其他潜在 ESKD 病因相比，ADPKD 是否会影响 AVF/AVG 的通畅率。
我们使用 2011 年至 2020 年期间瑞典肾脏登记处的数据进行了回顾性队列研究，随访至 2022 年。我们纳入了 496 例 ADPKD 患者和 4321 名倾向评分匹配的对照者。使用 Kaplan-Meier 生存曲线和 Mantel-Cox 对数秩检验比较 ADPKD 患者和非 ADPKD 患者的 VA 通畅率。还分析了维持或恢复通畅的干预措施。
ADPKD 患者占所有患者的 8.0%，在 VA 建立的预 ESKD 阶段比例更高（51.6%比 40.6%）。ADPKD 患者与非 ADPKD 患者在原发性、血管腔内置管后原发性、继发性或功能性通畅率方面无显著差异。然而，ADPKD 患者中更多 VA 被结扎（10.5%比 7.7%， = 0.03），且他们接受了更多首次干预以恢复血流（49.4%比 41.9%， = 0.02）。
这些发现表明，无论是否患有 ADPKD，ESKD 患者的 AVF/AVG 通畅率仍然相当，ADPKD 患者的 VA 监测和治疗策略应与其他 ESKD 病因患者的策略保持一致。
