中华肾脏病杂志2024，Vol.40Issue(2) ：111-117.DOI:10.3760/cma.j.cn441217-20230830-00845

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

党香云 李慧贤 张晓田 刘超 杨世峰 路万虹
中华肾脏病杂志2024，Vol.40Issue(2) ：111-117.DOI:10.3760/cma.j.cn441217-20230830-00845
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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

党香云 1李慧贤 1张晓田 2刘超 1杨世峰 1路万虹1
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作者信息

  • 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
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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 m2)-1 组,10≤eGFR＜15 ml·min-1·(1.73 m2)-1组及 eGFR≥15 ml·min-1·(1.73 m2)-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eGFR7.7(6.6,9.2)ml·min-1·(1.73 m2)-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 m2)-1组及 10≤eGFR＜15 ml.min-1·(1.73 m2)-1组相比,eGFR ≥1 5 ml·min-1·(1.73 m2)-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 m2)-1组及 eGFR≥15 ml·min-1·(1.73 m2)-1组相比,eGFR＜10 ml·min-1·(1.73 m2)-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(x2=4.033,P=0.045)及6个月内启动HD比例(x2=5.012,P=0.025)较低,其他指标差异均无统计学意义(均P＞0.05).从AVF建立到启动规律HD的中位时间为84(49,174)d,术后3个月内、6个月内、1年内启动HD治疗的患者分别为112例(50.9％)、152例(69.1％)、202例(91.8％).多因素Cox比例风险回归模型分析显示,血清胱抑素C水平高(HR=1.283,95％CI 1.121～1.469,P＜0.001)的 NDKD患者在 AVF术后 1 年内更早启动 HD.156例(70.9％)患者在首次HD时使用AVF,在AVF术后≤90d、91～180d、≥181 d首次HD治疗时使用AVF的患者分别为72例(64.3％)、40例(100.0％)、44例(88.0％).多因素Logistic回归分析未发现NDKD患者首次HD使用AVF的相关因素.结论 胱抑素C可能是NDKD患者AVF术后1年内启动HD的独立相关因素.

Abstract

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 m2)-1],group 2[eGFR between 10 to 15 ml·min-1·(1.73 m2)-1],and group 3[eGFR＞15 ml·min-1·(1.73 m2)-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 m2)-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 months(x2=4.033,P=0.045)and 6 months(x2=5.012,P=0.025)were lower in age＜65 years group.The median time interval between AVF creation and HD initiation among these patients was 84(49,174)days.The patients initiating HD within 3 months,6 months,and 1 year after AVF creation were 112(50.9％),152(69.1％),and 202(91.8％),respectively.Multivariate Cox regression analysis indicated that higher cystatin C level(HR=1.283,95％CI 1.121-1.469,P＜0.001)was associated with earlier HD initiation within 1 year of AVF surgery in NDKD patients.AVF usage was accomplished in 64.3％of patients who initiated HD within 90 days,the ratio was 100.0％in those initiated HD between 91 to 180 days,and 88.0％in those ≥181 days after AVF surgery.No factor was independently associated with AVF use at HD initiation identified by multivariate logistic regression analyses in patients with NDKD.Conclusion Serum cystatin C level is associated with HD initiation within 1 year of the predialysis AVF creation in NDKD patients.

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

Key words

Arteriovenous fistula/Renal insufficiency,chronic/Renal dialysis/Risk factors/Non-diabetic kidney disease

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基金项目

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

出版年

2024
中华肾脏病杂志
中华医学会

中华肾脏病杂志

CSTPCDCSCD北大核心
影响因子：1.182
ISSN：1001-7097
参考文献量25
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