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| Analysis of Factors Related to Vascular Access Selection and Internal Fistula Use in Patients with End-stage Renal Disease |
| ZHAO Yanhong, LI Hongmei, YANG Chongmeng, et al |
| Yuxi People's Hospital, Yunnan Yuxi 653100, China |
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Abstract 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 (χ2=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.
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2020, Vol. 26 
