终末期肾脏病患者初次HD血管通路选择及内瘘使用相关因素分析

Analysis of Factors Related to Vascular Access Selection and Internal Fistula Use in Patients with End-stage Renal Disease

目的:探究终末期肾脏病患者初次血液透析(HD)血管通路选择及内瘘使用相关因素分析。方法:选取2017年6月至2019年1月期间在我院肾内科血液净化中心登记进行HD的ESRD患者80例为研究对象,根据患者血管通路建立情况,将患者分为AVF和CVC组。比较两组临床资料并分析患者初次HD时血管通路选择的影响因素。结果:80例ESRD患者中,建立AVF的患者有12例(15%),建立CVC的有68例(85%)。单因素分析显示,两组ESRD患者性别、年龄、BMI、肾小球滤过率、ESRD病因等影响对患者血管通路选择差异均无统计学意义(P>0.05)。随访6个月后,AVF组并发症总发生率为25%,CVC组为57.35%,两组比较差异具有统计学意义(χ^2=4.281,P<0.05)。且80例患者维持性透析中6个月内,AVF组患者转为肾移植的有1例,11例仍使用AVF治疗,治疗转换率为8.33%(1/12);CVC组改为AVF的有48例,改为腹膜透析有5例,改为肾移植有2例,仅13例仍为CVC,治疗转换率为80.88%(55/68)。多因素Logistic回归分析显示,文化程度、区域分布、户口所在地、建议造瘘至开始透析时间均为AVF使用的相关影响因素(B=-2.954、3.024、-2.479、-2.259,P均<0.05)。结论:大部分HD患者初次透析血管通路为深静脉导管,初次透析AVF使用率很低。且初次透析时AVF的使用率影响因素涉及多方面,其中教育程度、区域分布、户口所在地、建议造瘘至开始透析时间均会影响患者的选择。

Objective:To explore the selection of vascular access and the use of internal fistula in patients with end-stage renal disease.Methods:80 ESRD patients enrolled for hemodialysis in the blood purification center of the department of nephrology of our hospital from June 2017 to January 2019 were selected as the study objects.According to the establishment of vascular access,the patients were divided into arteriovenous fistula and central venous catheter group.The clinical data of the two groups were compared and the influencing factors of vascular access selection in patients with initial hemodialysis were analyzed.Results:Of the 80 ESRD patients,12(15%)established AVF and 68(85%)established CVC.Univariate analysis showed that gender,age,BMI,glomerular filtration rate and ESRD etiology of ESRD patients in the two groups had no statistically significant difference in vascular access selection(P>0.05).After 6 months of follow-up,the overall incidence of complications was 25%in the AVF group and 57.35%in the CVC group,indicating a statistically significant difference between the two groups(χ^2=4.281,P<0.05).In addition,within 6 months of 80 patients undergoing maintenance dialysis,1 patient in the AVF group was converted to kidney transplantation,and 11 patients were still treated with AVF,with a treatment conversion rate of 8.33%(1/12).In the CVC group,48 patients were converted to AVF,5 to peritoneal dialysis,2 to kidney transplantation,and only 13 remained CVC,with a treatment conversion rate of 80.88%(55/68).Multivariate Logistic regression analysis showed that education level,regional distribution,residence location,and the time from the recommended fistula to the start of dialysis were all relevant influencing factors for the use of AVF(B=-2.954,3.024,-2.479,-2.259,P均<0.05).Conclusion:Most HD patients were treated with deep vein catheter for the first time,and the use rate of AVF was very low.In addition,there are many factors influencing the use rate of AVF during the first dialysis,including education level,regional distribution,registered permanent residence location,and the recommended time from fistulation to the beginning of dialysis.