山西省维持性血液透析患者血管通路方式调查

目的了解山西省维持性血液透析(MHD)患者血管通路方式的现状,分析影响血管通路选择的因素及MHD患者死亡的危险因素。方法选取2014年1月至2018年12月山西省所有开展血液净化治疗的医疗机构网上直报的MHD患者为研究对象,收集患者临床资料,入选者血管通路信息明确。采用多因素Logistic回归方程法分析MHD患者血管通路选择的影响因素及死亡的危险因素。结果10236例MHD患者入选本研究,选择自体动静脉内瘘(AVF)为血管通路者9130例(89.2%),首次透析选择无隧道无涤纶套中心静脉导管(NCC)者5138例(占50.2%)。多因素Logistic回归分析结果显示,原发病为糖尿病肾病(OR=0.517,95%CI 0.281~0.796,P<0.001)、透析龄<1年(OR=0.483,95%CI 0.219~0.811,P<0.001)是MHD患者不选择AVF方式透析的影响因素。原发病为糖尿病肾病(OR=2.242,95%CI 1.816~2.828,P<0.001)、使用中心静脉导管透析(OR=1.785,95%CI 1.237~2.579,P<0.001)是MHD患者死亡的独立危险因素。结论山西省MHD患者的首选血管通路方式为AVF,使用NCC作为首次透析的血管通路的占比较高。原发病为糖尿病肾病、透析龄<1年是MHD患者不选择AVF方式的影响因素。原发病为糖尿病肾病、使用中心静脉导管透析可增加MHD患者的死亡风险。

Investigation of vascular access in maintenance hemodialysis patients in Shanxi province

Objective To understand the current situation of vascular access selection in maintenance hemodialysis (MHD) patients in Shanxi Province, and analyze the factors affecting vascular access selection and risk factors of death in MHD patients. Methods MHD patients with clear vascular access information in Shanxi Province from January 2014 to December 2018 were enrolled in this study. The clinical data of patients were collected. The vascular access information of the selected candidates was clear. Multivariate logistic regression equation method was used to analyze the influencing factors of vascular access and the risk factors of death in MHD patients. Results Among the 10.236 patients with MHD, 9.130 patients (89.2%) selected autologous arteriovenous fistula (AVF) as vascular access, and 5.138 patients (50.2%) chose tunnel-free and non-polyester sheath central venous catheter (NCC) for the first dialysis. Multivariate logistic regression analysis showed that the primary disease of diabetic nephropathy (OR=0.517, 95%CI 0.281-0.796, P＜0.001) and dialysis age＜1 year (OR=0.483, 95%CI 0.219-0.811, P＜0.001) were the influencing factors of patients with MHD who did not to choose AVF. Primary disease of diabetic nephropathy (OR=2.242, 95% CI 1.816-2.828, P＜0.001), and using of central vein catheter (OR=1.785, 95% CI 1.237-2.579, P＜0.001) were independent risk factors of death in MHD patients. Conclusions AVF is the first choice for MHD patients in Shanxi Province. There is higher proportion of the use of NCC as the first dialysis vascular access. Primary disease of diabetic nephropathy and dialysis age＜1 year are the influencing factors for MHD patients not to choose AVF. Primary disease of diabetic nephropathy and use of central vein catheter may increase the risk of death in MHD patients.