Ghonimi Tarek A, Hamad Abdullah, Elgaali Musaab, Farid Mohamed, Ezat Mohamed, A/Aziz Rania, Amin Mohamed, Al-Malki Hassan, Alkadi Mohamad
Division of Nephrology, Department of Medicine Hamad Medical Corporation Doha Qatar.
Health Sci Rep. 2025 Sep 21;8(9):e70881. doi: 10.1002/hsr2.70881. eCollection 2025 Sep.
The demand for hemodialysis (HD) among patients with end-stage kidney disease (ESKD) is rising globally. A well-functioning vascular access (VA) is crucial for effective dialysis therapy. This study aims to determine the incidence and risk factors of primary arterio-venous access (AVA) maturation failure in HD patients.
This retrospective cohort study included adult HD patients who underwent AVA creation between 01/01/2021 and 31/12/2023 in Qatar. Data, including demographics, medical comorbidities, AVA type, time to maturation, and incidence of AVA failure, were obtained from a national electronic health record system.
Among 242 AVA creations, the primary AVA failure rate was 28%, with an incidence of 9.3 per 100 cases per year. Failure was significantly higher in older patients ( < 0.001), those with diabetes mellitus ( = 0.03), atherosclerosis ( = 0.02), and lower systolic and diastolic blood pressures ( = 0.02 and < 0.001, respectively). Statin use was higher in patients with matured AVA (68.9% vs. 45.5%; < 0.001). Multivariate analysis identified diabetes mellitus [OR: 3.672 (95%CI: 1.532-8.801); = 0.004], atherosclerosis [OR: 2.348 (95%CI: 1.001-5.504); = 0.002], and age [OR: 1.036 (95%CI: 1.010-1.064); = 0.007] as risk factors for failure. Statin use [OR: 0.167 (95%CI: 0.080-0.347); < 0.001] and higher systolic blood pressure [OR: 0.989 (95%CI: 0.966-1.000); = 0.05] were protective factors.
Primary AVA failure in hemodialysis patients in Qatar is notably high, with advanced age, diabetes, atherosclerosis, and low blood pressure increasing risk. Statin use and higher systolic blood pressure provide protective effects. These findings highlight the need for managing risk factors to improve AVA maturation success and enhance dialysis outcomes.
全球范围内，终末期肾病（ESKD）患者对血液透析（HD）的需求不断上升。功能良好的血管通路（VA）对于有效的透析治疗至关重要。本研究旨在确定血液透析患者原发性动静脉内瘘（AVA）成熟失败的发生率及危险因素。
这项回顾性队列研究纳入了2021年1月1日至2023年12月31日在卡塔尔接受AVA造瘘的成年血液透析患者。数据包括人口统计学信息、合并症、AVA类型、成熟时间以及AVA失败发生率，均来自国家电子健康记录系统。
在242例AVA造瘘病例中，原发性AVA失败率为28%，年发生率为每100例9.3例。老年患者（<0.001）、糖尿病患者（=0.03）、动脉粥样硬化患者（=0.02）以及收缩压和舒张压较低的患者（分别为=0.02和<0.001）失败率显著更高。AVA成熟患者的他汀类药物使用率更高（68.9%对45.5%；<0.001）。多因素分析确定糖尿病[比值比（OR）：3.672（95%置信区间：1.532 - 8.801）；=0.004]、动脉粥样硬化[OR：2.348（95%置信区间：1.001 - 5.504）；=0.002]和年龄[OR：1.036（95%置信区间：1.010 - 1.064）；=0.007]为失败的危险因素。他汀类药物使用[OR：0.167（95%置信区间：0.080 - 0.347）；<0.001]和较高的收缩压[OR：0.989（95%置信区间：0.966 - 1.000）；=0.05]为保护因素。
卡塔尔血液透析患者原发性AVA失败率显著较高，高龄、糖尿病、动脉粥样硬化和低血压会增加风险。他汀类药物使用和较高的收缩压具有保护作用。这些发现凸显了管理危险因素以提高AVA成熟成功率和改善透析结局的必要性。
