Evaluation of variables associated with the patency of arteriovenous fistulas for hemodialysis created by a nephrologist

ABSTRACT Introduction: Arteriovenous fistula (AVF) is considered the gold standard vascular access for chronic hemodialysis, and its failure predicts higher morbidity and mortality rates. Objective: 1) To evaluate the success rate of AVF created by a nephrologist and 2) to identify clinical, laboratory, and demographic variables that influence AVF patency. Methods: A retrospective cohort study of 101 patients with chronic kidney disease for a total of 159 AVF created by a nephrologist between June 2010 and June 2013. Results: Of the AVFs created, 124 (78%) displayed immediate patency and 110 (62.9%) displayed late patency. Hemoglobin (10-12 g/dL) was the only variable related to late AVF patency (p = 0.05). An elevated blood pressure at time of surgery was associated with a lower number of procedures per patient (p = 0.001). Proximal AVF occurred more frequently in patients with dual access (p = 0.03). The AVF success rate was similar to those previously reported in the literature. Conclusion: Hemoglobin level in the recommended range has a favorable impact on late AVF patency and elevated blood pressure during surgery on the lower number of vascular accesses per patient. The high success rate indicates that it can be placed by trained nephrologists.

摘要 引言：动静脉内瘘（Arteriovenous fistula, AVF）被视为慢性血液透析的金标准血管通路，其功能失效会伴随更高的发病率与死亡率。研究目标：1）评估由肾病专科医师实施的动静脉内瘘手术成功率；2）明确影响动静脉内瘘通畅性的临床、实验室及人口统计学变量。研究方法：本研究为回顾性队列研究，纳入2010年6月至2013年6月期间由肾病专科医师实施的101例慢性肾脏病患者的共计159次动静脉内瘘手术。研究结果：在所完成的动静脉内瘘手术中，124例（78%）实现即刻通畅，110例（62.9%）实现远期通畅。血红蛋白水平处于10~12 g/dL范围是唯一与动静脉内瘘远期通畅相关的变量（p=0.05）。手术时的血压升高与每位患者的手术操作次数减少显著相关（p=0.001）。近端动静脉内瘘在具备双重血管通路的患者中更为常见（p=0.03）。本研究中动静脉内瘘的成功率与既往文献报道的结果相近。研究结论：处于推荐范围内的血红蛋白水平对动静脉内瘘的远期通畅具有积极作用，手术时的血压升高则会降低每位患者的血管通路操作次数。较高的手术成功率表明，经专业培训的肾病专科医师可安全开展此类手术。