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The outcome of the primary vascular access and its translation into prevalent access use rates in chronic haemodialysis patients

机译:慢性血液透析患者主要血管通路的结果及其转化为普遍通路使用率

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BackgroundThe American Fistula First Breakthrough Initiative currently aims for a 66 arterio-venous fistula (AVF) rate, while in the UK, best practice tariffs target AVF and arterio-venous graft (AVG) rates of 85. The present study aims to assess whether these goals can be achieved. MethodsWe conducted a retrospective cohort study on patients who initiated haemodialysis from 1995 to 2006. Outcomes were the final failure-free survival of the first permanent access and the type of second access created. Prevalent use rates for the access types were calculated on the 1st January of each year for the second half of the study period. ResultsTwo hundred and eleven out of 246 patients (86) received an AVF, 16 (6) an AVG and 19 (8) a permanent catheter (PC) as the first permanent access. Eighty-six (35) patients had final failure of the primary access. One-and 3-year final failure-free survival rates were 73 and 65 for AVF compared with 40 and 20 for AVG and 62 and 0 for PC, respectively. In patients with primary AVF, female sex hazard ratio (HR) 2.20 [confidence interval (CI) 1.293.73] and vascular disease [HR 2.24 (CI 1.26-3.97)] were associated with a poorer outcome. A similar trend was observed for autoimmune disease [HR 2.14 (CI 0.99-4.65)]. As second accesses AVF, AVG and PC were created in 47 (n=40), 38 (n=33) and 15 (n=13). The median prevalent use rate was 80.5 for AVF, 14 for AVG and 5.5 for PC. ConclusionsThe vascular access targets set by initiatives from the USA and UK are feasible in unselected haemodialysis patients. High primary AVF rates, the superior survival rates of AVFs even in patient groups at higher risk of access failure and the high rate of creation of secondary AVFs contributed to these promising results.
机译:背景技术“美国瘘管首次突破性倡议”目前的目标是将动静脉瘘(AVF)的比率定为66,而在英国,最佳做法关税的目标是将AVF和动静脉移植物(AVG)的比率定为85。本研究旨在评估这些比率是否目标可以实现。方法我们对1995年至2006年开始进行血液透析的患者进行了一项回顾性队列研究。结果是首次永久性通路的最终无失败生存率和所产生的第二次通路的类型。在研究期的下半年,每年的1月1日计算访问类型的普遍使用率。结果246例患者中有211例(86)接受了AVF,16例(6)接受了AVG,19例(8)接受了永久性导管(PC)作为首次永久性入路。八十六(35)例患者的主要通路最终失败。 AVF的一年和三年最终无故障生存率分别为73和65,而AVG分别为40和20,PC为62和0。在原发性AVF患者中,女性性别危险比(HR)2.20 [置信区间(CI)1.293.73]和血管疾病[HR 2.24(CI 1.26-3.97)]与预后较差相关。自身免疫性疾病也观察到类似趋势[HR 2.14(CI 0.99-4.65)]。作为第二次访问,在47(n = 40),38(n = 33)和15(n = 13)中创建了AVF,AVG和PC。 AVF的中位普遍使用率为80.5,AVG为14,PC为5.5。结论美国和英国的倡议设定的血管通路目标在未选择的血液透析患者中​​是可行的。较高的原发性AVF率,较高的AVF生存率,即使在具有较高接入失败风险的患者组中,以及较高的继发性AVF产生率也为这些有希望的结果做出了贡献。

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