Comparison of the effect of different vascular access routes on elderly patients with maintenance hemodialysis

doi:10.11958/20241310

Abstract

Abstract:

Objective To compare the effects of 2 vascular accesses via arteriovenous fistula (AVF) and tunnel-cuffed catheter (TCC) in elderly patients with maintenance hemodialysis (MHD). Methods A total of 103 elderly MHD patients were selected and divided into the AVF group (43 cases) and the TCC group (60 cases) according to different vascular pathways. Laboratory indexes of serum creatinine, uric acid, parathyroid hormone (PTH), serum calcium, blood phosphorus, hemoglobin, triglyceride and total cholesterol were compared between the two groups on dialysis day after receiving regular hemodialysis treatment for 1 year. Blood flow and urea clearance in vascular pathway were also compared between the two groups. The left ventricular end-diastolic diameter (LVEDd), the left ventricular posterior end-diastolic thickness (LVPWT), the ventricular septal end-diastolic thickness (IVSTd), ejection fraction (EF), the maximum flow velocity ratio (E/A) of the left atrial ventricle at the early and late diastolic stages and pulmonary artery pressure were examined by echocardiography after regular hemodialysis treatment for 1 year. The occurrence rates of left ventricular systolic dysfunction and diastolic dysfunction were recorded. Hemodialysis access associated infection, mechanical injury and heart failure during dialysis were also recorded. Results There were no significant differences in laboratory indexes between the two groups (P>0.05). LVEDd, IVSTd, LVPWT, incidence rates of left ventricular systolic dysfunction, diastolic dysfunction, blood flow through vascular channels, Kt/V and mechanical injury were higher in the AVF group than those in the TCC group, while the ratio of hemodialysis access associated infection, E/A and EF values were lower in the AVF group than those in the TCC group (P<0.05). There were no significant differences in incidence rates of pulmonary arterial pressure and heart failure between the two groups (P>0.05). Conclusion For elderly MHD patients, the appropriate dialysis access should be determined after evaluating underlying diseases and vascular conditions.

Key words: arteriovenous fistula, renal dialysis, catheters, indwelling, postoperative complications, cardiac function, dialysis adequacy

CLC Number:

R459.5

Figures/Tables 5

References 20

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组别	n	男/女	年龄/岁	原发病
组别	n	男/女	年龄/岁	糖尿病肾病	慢性肾小球肾炎	其他^#
AVF组	43	26/17	67.63±5.96	15（34.9）	13（30.2）	15（34.9）
TCC组	60	29/31	70.25±8.94	25（41.7）	12（20.0）	23（38.3）
χ²或t		1.482	1.675	1.458
组别		收缩压/mmHg		舒张压/mmHg		治疗前Scr/（μmol/L）
AVF组		158.93±24.82		83.74±13.35		711.30（501.90，905.00）
TCC组		156.28±23.18		82.37±15.75		624.50（431.65，856.38）
t或Z		0.555		0.466		1.455

组别	n	男/女	年龄/岁	原发病
组别	n	男/女	年龄/岁	糖尿病肾病	慢性肾小球肾炎	其他^#
AVF组	43	26/17	67.63±5.96	15（34.9）	13（30.2）	15（34.9）
TCC组	60	29/31	70.25±8.94	25（41.7）	12（20.0）	23（38.3）
χ²或t		1.482	1.675	1.458
组别		收缩压/mmHg		舒张压/mmHg		治疗前Scr/（μmol/L）
AVF组		158.93±24.82		83.74±13.35		711.30（501.90，905.00）
TCC组		156.28±23.18		82.37±15.75		624.50（431.65，856.38）
t或Z		0.555		0.466		1.455

组别		n		治疗后Scr/（μmol/L）		UA/（μmol/L）
AVF组		43		689.00（601.00，852.00）		322.00（228.00，401.50）
TCC组		60		607.95（498.45，783.73）		308.00（255.00，367.00）
Z				1.933		0.091
组别	PTH/（ng/L）				血钙/（mmol/L）		血磷/（mmol/L）
AVF组	312.10（132.78，402.45）				2.28（2.17，2.44）		1.48（1.23，2.06）
TCC组	195.80（116.45，352.50）				2.27（2.13，2.36）		1.49（1.16，1.92）
Z	1.551				1.532		0.635
组别			Hb/（g/L）		TG/（mmol/L）		TC/（mmol/L）
AVF组			112.23±17.35		1.13（0.81，1.85）		3.57（2.80，3.79）
TCC组			109.00±15.45		1.38（1.17，1.91）		4.00（2.93，4.72）
Z或t			0.994		1.929		1.685

组别		n		治疗后Scr/（μmol/L）		UA/（μmol/L）
AVF组		43		689.00（601.00，852.00）		322.00（228.00，401.50）
TCC组		60		607.95（498.45，783.73）		308.00（255.00，367.00）
Z				1.933		0.091
组别	PTH/（ng/L）				血钙/（mmol/L）		血磷/（mmol/L）
AVF组	312.10（132.78，402.45）				2.28（2.17，2.44）		1.48（1.23，2.06）
TCC组	195.80（116.45，352.50）				2.27（2.13，2.36）		1.49（1.16，1.92）
Z	1.551				1.532		0.635
组别			Hb/（g/L）		TG/（mmol/L）		TC/（mmol/L）
AVF组			112.23±17.35		1.13（0.81，1.85）		3.57（2.80，3.79）
TCC组			109.00±15.45		1.38（1.17，1.91）		4.00（2.93，4.72）
Z或t			0.994		1.929		1.685

组别		n		LVEDd/mm	IVSTd/mm		LVPWT/mm		E/A
AVF组		43		56.21±4.15	12.22±1.79		11.92±1.32		0.79±0.28
TCC组		60		50.07±6.01	10.32±1.42		10.07±1.39		1.22±0.48
t				5.493^＊＊	5.658^＊＊		6.444^＊＊		4.893^＊＊
组别	n		肺动脉压/ mmHg		EF	左心室收缩功能障碍		左心室舒张功能障碍
AVF组	43		45.63±8.93		0.47±0.06	32（82.05）		30（76.92）
TCC组	60		46.16±10.37		0.54±0.07	16（41.03）		16（30.77）
t或χ²			0.343		5.316^＊＊	24.918^＊＊		18.991^＊＊