终末期肾病患者桡动脉-头静脉内瘘初级通畅率影响因素的回顾性队列研究

Primary patency of radio-cephalic fistulas in patients with end stage kidney disease: a retrospective cohort study

目的:通过回顾性队列研究探讨终末期肾病患者桡动脉-头静脉内瘘(RCF)建立后初级通畅率影响因素。方法:从2016年1月至2019年6月在山东第一医科大学第一附属医院肾病学科诊断为慢性肾脏病(CKD) 4~5期且初次行RCF的276例患者建立回顾性队列,随访时间截止于2021年11月,中位随访时间40月。收集入组患者年龄、性别、用药史、生化指标等临床资料,应用Kaplan-Meier生存曲线计算RCF的通畅率。RCF失功定义为血管狭窄(血管直径狭窄≥50%)或血栓形成不能提供充足的血流量完成透析治疗。COX多因素回归分析探讨影响RCF失功的因素。结果:患者平均年龄为51.7±14.6岁,60.9%为男性。在CKD的病因中慢性肾小球肾炎占44.6%,糖尿病肾脏疾病占31.1%。在整个随访过程中,68例(24.6%)患者发生RCF的失功。Kaplan-Meier生存曲线分析显示,RCF建立后第12个月、24个月、36个月、48个月、60个月的初级通畅率分别为89.5%、83.0%、78.3%、75.7%和75.7%。COX多因素模型分析显示,年龄(≥65岁)为RCF失功的危险因素(HR=2.83,95%CI 1.30~6.19);校正钙(每增加1 mg/d L)为RCF失功的保护因素(HR=0.66,95%CI 0.47~0.94);而性别、糖尿病、高血压、血脂、血磷、甲状旁腺激素等与RCF的失功不相关。结论:终末期肾病患者RCF建立后初级通畅率在12月和24月分别为89.5%,83.0%。随着时间的推进,其通畅率开始缓慢下降,年龄与校正钙水平与RCF的失功密切相关。

Objective: A retrospective cohort study was conducted to explore influencing factors of primary patency rate of radio-cephalic fistula( RCF) in patients with end stage kidney disease. Methodology: 276 patients with chronic kidney disease( CKD) stage 4-5 who underwent RCF creation for the first time in our hospital from January 2016 to June2019 were enrolled. The follow-up time ended in November 2021,with a median follow-up of 40 months. Clinical data and biochemical parameters were collected. Kaplan-Meier survival curve was used to calculate the patency rate of RCF. RCF failure was defined as vascular stenosis( vessel diameter stenosis≥50%) or thrombosis,which could not provide sufficient blood flow to complete dialysis treatment. Multivariate Cox regression analysis was used to explore the related factors of RCF failure. Results: The mean age of the patients was 51. 7±14. 6 years,and 60. 9% were male. Chronic glomerulonephritis accounted for 44. 6% of CKD and diabetic nephropathy accounted for 31. 1%. During follow-up,68( 24. 6%) patients developed fistula failure. Kaplan-Meier survival curve analysis showed that the primary patency rates at 12,24,36,48 and60 months after establishment of RCF were 89. 5%,83. 0%,78. 3%,75. 7% and 75. 7%,respectively. Multivariate COX model analysis showed that age( ≥65 years) was a risk factor for RCF failure,with HR value of 2. 83 and 95%CI of 1. 30~ 6. 19. Adjusted calcium( per increase of 1mg/d L) was a protective factor for the RCF failure,with HR value of 0. 66 and95%CI of 0. 47 ~ 0. 94. However,gender,diabetes mellitus,hypertension,blood lipids,blood phosphorus and parathyroid hormone were not associated with RCF failure. Conclusion: In this study,it was found that the primary patency rates of RCF creation were 89. 5% and 83. 0% at 12 and 24 months,respectively. The patency rate began to decline slowly over time. Age and corrected calcium level were significantly related to RCF failure.