Feldman H I, Held P J, Hutchinson J T, Stoiber E, Hartigan M F, Berlin J A
University of Pennsylvania School of Medicine, Philadelphia.
Kidney Int. 1993 May;43(5):1091-6. doi: 10.1038/ki.1993.153.
Extensive morbidity related to hemodialysis vascular access exists among end-stage renal disease (ESRD) patients, but the risk factors for this morbidity have not been extensively studied. Medicare ESRD patient data were obtained from 1984, 1985, and 1986. Hospitalization for vascular access morbidity (ICD-996.1, 996.6, or 996.7) was analyzed among prevalent patients and, using survival analysis, among incident patients to assess sex, age, race, and underlying cause of renal failure as risk factors. We found that 15 to 16% of hospital stays among prevalent ESRD patients were associated with vascular access-related morbidity. Black race, older age, female sex, and diabetes mellitus as a cause of kidney failure were all independent risk factors for access-related morbidity. The rate ratio comparing Blacks to Whites was 1.12 (95% C.I., 1.09, 1.16); > 64 years to 20 to 44 years, 1.53 (1.46, 1.59); men to women, 0.81 (0.79, 0.84); and diabetes to glomerulonephritis, 1.29 (1.24, 1.35). We conclude that hemodialysis vascular access malfunction causes much hospitalization among ESRD patients. Women, Blacks, the elderly, and diabetics appear to be at particularly high risk, and additional studies are needed to understand these patterns.
终末期肾病（ESRD）患者中存在与血液透析血管通路相关的大量发病情况，但对此类发病的危险因素尚未进行广泛研究。医疗保险ESRD患者数据取自1984年、1985年和1986年。对现患患者中因血管通路发病而住院（国际疾病分类第九版编码996.1、996.6或996.7）的情况进行了分析，并采用生存分析方法对新发病例患者进行分析，以评估性别、年龄、种族和肾衰竭的潜在病因作为危险因素。我们发现，ESRD现患患者中15%至16%的住院与血管通路相关发病有关。黑人种族、高龄、女性以及糖尿病作为肾衰竭病因均是与通路相关发病的独立危险因素。黑人与白人的率比为1.12（95%置信区间为1.09至1.16）；64岁以上与20至44岁相比，为1.53（1.46至1.59）；男性与女性相比，为0.81（0.79至0.84）；糖尿病与肾小球肾炎相比，为1.29（1.24至1.35）。我们得出结论，血液透析血管通路故障在ESRD患者中导致大量住院情况。女性、黑人、老年人和糖尿病患者似乎风险尤其高，需要进一步研究以了解这些模式。
