JAMA Surg:透析患者自体动静脉内瘘的成熟度、功能通畅率和后期干预率研究

2021-09-28 MedSci原创 MedSci原创

自体动静脉内瘘是一种可接受的血液透析途径,尽管其成熟和后续使用都需要适度的干预以维持通畅性和治疗相关并发症

自体动静脉内瘘(AVF)是血液透析血管通路的重要方法,其具有通畅性高,并发症风险低,患者死亡率和治疗成本低的特点。近日研究人员考察了在临床实践中,AVF的可用性、长期功能通畅性、并发症处理或保持通畅的补救方法等。

HFM研究是一项多中心前瞻性国家卫生研究院国家糖尿病消化和肾脏疾病队列研究,研究目的是确定与AVF临床应用效果的相关因素。总计包含535名接受AVF的参与者,患者在各个临床中心接受AVF,在术后6周不鼓励采取补救措施。研究的主要终点为无辅助措施的内瘘成熟、通畅率、无干预和参与者生存率。

参与者中,男性372人(69.5%),糖尿病患者311例(58.1%),平均年龄为54.6岁。近三分之二的AVFs(342例,64%)位点在上臂。肾衰竭和CKD患者的3个月时AVF成熟率分别为29%和10%,6个月时分别为67%和38%,12个月时分别为76%和58%。133例肾衰竭(37.7%)和63例CKD(34.6%)患者接受了干预,以促进成熟或在成熟前处理并发症。从通路建立到成熟的中位时间为115天, CKD患者平均内瘘成熟时间为170天长于肾衰竭患者的105天。1年成熟AVFs的功能通畅率为87%,2年成熟AVFs的功能通畅率为75%,近一半(188例,47.5%)患者,AVFs成熟后有进一步的干预以维持通畅或治疗并发症。

AVF后内瘘成熟率

研究认为,自体动静脉内瘘是一种可接受的血液透析途径,尽管其成熟和后续使用都需要适度的干预以维持通畅性和治疗相关并发症

原始出处:

Thomas S. Huberet al. Arteriovenous Fistula Maturation, Functional Patency, and Intervention Rates. JAMA Surg. September 22, 2021.

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    2021-09-29 学医无涯

    学习一下

    0

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    2021-09-29 小王大夫123

    欧力给

    0

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