北京市单中心初始血液透析动-静脉内瘘使用情况及相关因素分析

Predictors of incident arteriovenous fistula use in incident hemodialysis patients.. A single-central hospital in Beijing

目的调查维持性血液透析（maintenance hemodialysis，MHD）患者初始透析动一静脉内瘘使用情况，并分析其相关因素，为提高初始透析动一静脉内瘘使用率提供参考依据。方法选择2012年1～3月北京市海淀医院接受维持性血液透析患者86例，采用问卷调查方式记录患者一般情况（如年龄、性别、婚姻状况、文化程度、职业、家庭收入）；患者疾病相关情况[如原发病、透析时间、肾科专科随访时间、在预计进入透析前半年行建立透析通路告知（以下称“预先通路告知”）、告知透析医院级别、居住地与最近医院距离、居住地与透析医院距离]；对上述指标进行量化后Logistic回归分析。结果北京市海淀区单中心初始血液透析动一静脉内瘘使用率约为30．2％（26／86），肾科专科随访1年以上（OR值4．825，P=0．02）、预先通路告知（0R值22．15，P=0．006）是主要影响因素。结论早期肾科专科随访、预先通路告知是影响维持性血液透析患者首次透析动一静脉内瘘使用的重要因素，慢性肾脏病患者早期肾科专科就诊、告知患者选择合适时机建立动一静脉内瘘可以提高初始血液透析动一静脉内瘘使用率。

Objective To identify factors associated with incident arteriovenous fistula （AVF） use among incident hemodialysis （HD） patients. Methods A retrospective study was conducted in 86 maintenance hemodialysis （MHD） patients in Beijing Haidian Hospital from January 1 to March 31, 2012. Their general data including demographic characteristics （age, sex, marital status）, socioeconomic status （career,education level, income）, primary disease, time for referral to nephrology, hemodialysis access informed in advance, level of hospital informing hemodialysis for the first time, the distance be- tween residence and hemodialysis unit, the distance between residence and nearest hospital, were col- lected and analyzed by using binary Logistic regression. Results The incident AVF use rate was 30. 2~//00 in this study, which was lower than the target. Logistic regression indicated that early referral to nephrology and hemodialysis access informed in advance were the factors relating to incident AVF use in incident hemodialysis patients with the odds ratio of （OR 4. 825, P = 0. 02）, and （OR 22. 15, P = 0. 006） respectively. Conclusions Early referral to nephrology and hemodialysis access informed in ad- vance are the influencing factors on incident AVF use. The patients with chronic kidney disease should be transferred to nephrogy unit early and nephrologists should inform in advance patients to establish arteriovenous fistula at appropriate time.