非糖尿病肾脏疾病患者动静脉内瘘术后启动血液透析的影响因素  

Influencing factors for hemodialysis initiation in non-diabetic kidney disease patients with predialysis fistula after arteriovenous fistula creation

作　　者：党香云 李慧贤 张晓田[2] 刘超[1] 杨世峰[1] 路万虹[1] Dang Xiangyun;Li Huixian;Zhang Xiaotian;Liu Chao;Yang Shifeng;Lu Wanhong(Department of Nephrology,the First Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710061,China;Department of Human Anatomy,Histology and Embryology,Xi'an Jiaotong University Health Science Center,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院肾内科,西安710061 [2]西安交通大学医学部人体解剖学与组织胚胎学系,西安710061

出　　处：《中华肾脏病杂志》2024年第2期111-117,共7页Chinese Journal of Nephrology

基　　金：西安交通大学第一附属医院临床研究基金(XJTU1AF-CRF-2017-018)。

摘　　要：目的探讨行透析前计划自体动静脉内瘘(arteriovenous fistula,AVF)术的非糖尿病肾脏疾病(non-diabetic kidney disease,NDKD)患者启动血液透析(hemodialysis,HD)的影响因素。方法本研究为前瞻性队列研究。选取2015—2018年在西安交通大学第一附属医院肾脏内科行AVF手术的非透析NDKD患者为研究对象,并收集手术时一般资料及临床指标。依据慢性肾脏病流行病学协作公式估算肾小球滤过率(estimated glomerular filtration rate,eGFR)分为3组:eGFR<10 ml·min^(-1)·(1.73 m^(2))^(-1)组,10≤eGFR<15 ml·min^(-1)·(1.73 m^(2))^(-1)组及eGFR≥15 ml·min^(-1)·(1.73 m^(2))^(-1)组;依据年龄分为2组:<65岁组和≥65岁组。术后随访1年,主要终点事件为患者启动规律HD,次要终点事件为首次HD是否使用AVF。采用多因素Cox比例风险回归模型分析非透析NDKD患者AVF术后1年内启动HD的影响因素。采用Logistic回归模型分析非透析NDKD患者AVF术后首次HD使用AVF的影响因素。结果研究共纳入220例计划建立AVF的NDKD患者,年龄(48.1±16.2)岁,男性143例(65.0%),基线eGFR 7.7(6.6,9.2)ml·min^(-1)·(1.73 m^(2))^(-1),胱抑素C(3.93±1.12)mg/L,血白蛋白(36.0±4.0)g/L,24 h尿蛋白量(2.22±1.36)g,血磷(1.71±0.53)mmol/L。与eGFR<10 ml·min^(-1)·(1.73 m^(2))^(-1)组及10≤eGFR<15 ml·min^(-1)·(1.73 m^(2))^(-1)组相比,eGFR≥15 ml·min^(-1)·(1.73 m^(2))^(-1)组患者血红蛋白水平(F=3.112,P=0.047)、6个月内启动HD比例(Fisher值=6.832,P=0.020)较高;与10≤eGFR<15 ml·min^(-1)·(1.73 m^(2))^(-1)组及eGFR≥15 ml·min^(-1)·(1.73 m^(2))^(-1)组相比,eGFR<10 ml·min^(-1)·(1.73 m^(2))^(-1)组患者开始透析时间较短(H=6.295,P=0.043),其他指标差异均无统计学意义(均P>0.05)。与年龄≥65岁组相比,年龄<65岁组中血清白蛋白(t=2.076,P=0.039)、三酰甘油水平(t=1.995,P=0.048)较高,但3个月内启动HD比例(χ^(2)=4.033,P=0.045)及6个月内启动HD比例(χ^(2)=5.012,P=0.025)较低,其他指标差异均无统计�Objective To explore the influencing factors of hemodialysis(HD)initiation in non-diabetic kidney disease(NDKD)patients with predialysis arteriovenous fistula(AVF)creation.Methods This was a single-center prospective cohort study.The NDKD patients undergoing predialysis AVF creation were enrolled at the First Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2018.According to the estimated glomerular filtration rate(eGFR,the Chronic Kidney Disease Epidemiology Collaboration equation)and age,patients were divided into different subgroups,eGFR:group 1[eGFR<10 ml·min^(-1)·(1.73 m^(2))^(-1)],group 2[eGFR between 10 to 15 ml·min^(-1)·(1.73 m^(2))^(-1)],and group 3[eGFR>15 ml·min^(-1)·(1.73 m^(2))^(-1)];age:age≥65 years group and age<65 years group.The primary outcome was defined as the initiation of HD within 1 year after AVF surgery.The second outcome was the use of AVF access at the time of HD initiation.Cox proportional hazard regression was performed to identify which demographic and clinical factors were associated with the initiation of HD after AVF surgery.Logistic regression analysis was performed to investigate factors associated with AVF use at the initiation of HD.Results A total of 220 patients were enrolled,with age of(48.1±16.2)years,of which 143(65.0%)were males.Overall,the clinical parameters of eGFR,cystatin C,serum albumin,24h-Urine protein,serum phosphorus were as follows respectively,7.7(6.6,9.2)ml·min^(-1)·(1.73 m^(2))^(-1),(3.93±1.12)mg/L,(36.0±4.0)g/L,(2.22±1.36)g,(1.71±0.53)mmol/L.The proportion of patients initiating HD within 6 months(Fisher=6.832,P=0.020)and the level of hemoglobin(F=3.112,P=0.047)were higher in group 3 compared to the other two eGFR groups.While the median time interval between AVF creation and HD initiation(H=6.295,P=0.043)was shorter in group 1.In age<65 years group,the level of serum albumin(t=2.076,P=0.039),triglyceride(t=1.995,P=0.048)were higher compared with age≥65 years group;interestingly,the proportion of patients initiated HD within 3

关 键 词：动静脉瘘 肾功能不全 慢性 肾透析 危险因素 非糖尿病肾脏疾病 

分 类 号：R459.5[医药卫生—治疗学]