【摘要】目的探讨血液透析间期不同程度体质量增长对患者自体动静脉内瘘(arteriovenous fistula，AVF)失功的影响。方法采用回顾性队列研究设计，选取2009 年1 月～2019 年1 月在广东省人民医院接受维持性血液透析(maintenance hemodialysis，MHD)治疗的患者577 例,于2019 年1 月建立队列。收集患者入组前的临床资料，以患者2009 年每次透析前体质量和干体质量计算每次透析间期体质量增长(interdialytic weight gain，IDWG)并取平均值，观察指标为AVF 失功。结果研究对象分为IDWG≤4%组和IDWG＞4%组，用倾向性评分匹配法控制2 组混杂变量，共414 例患者完成1：1 匹配。匹配前后IDWG＞4% 组AVF 失功率均高于IDWG≤4% 组[34.2% 比65.8% ,χ2=5.718,P=0.017；14.5% 比22.7% ,χ2=4.611,P=0.032]；二元Logistic 回归分析结果显示，年龄(OR=3.393, 95% CI：1.861～6.184,P＜0.001)、IDWG(OR =1.967,95% CI：1.157～3.347,P=0.013)、血清白蛋白(OR=1.759,95% CI：1.034～2.990,P =0.037)、左心室质量指数(OR=1.008,95% CI：1.002～1.013,P=0.010)是AVF 失功的独立危险因素。结论IDWG 超过4%是MHD 患者AVF 失功的重要危险因素，特别是对于年龄大于60 岁、血清白蛋白低于35g/L、左心室质量指数高的患者。
陈迎归
,
宋利
,
孙春艳
,
周丽芳
,
郑淑倩
,
全梓林
,
赵立艳
,
崔冬梅
,
钟咪
,
赵宜娜
,
符霞
. 血液透析间期不同程度体质量增长对患者自体动静脉内瘘失功的影响[J]. 中国血液净化, 2021
, 20(06)
: 405
-409
.
DOI: 10.3969/j.issn.1671-4091.2021.06.013
【Abstract】Objective To explore the effect of interdialytic weight gain (IDWG) on the dysfunction of arteriovenous fistula (AVF) in maintenance hemodialysis (MHD) patients. Methods A total of 577 MHD patients treated in Guangdong Provincial People’s Hospital during the period from 2009 to 2019 were recruited for a retrospective and cohort study. Clinical data of the patients before entering the study were collected. The average IDWG was calculated based on the predialysis body weight and dry weight in every dialysis session in 2009. The observation index was AVF dysfunction. Results The MHD patients were divided into IDWG ≤4% group and IDWG >4% group. The two groups of confounding variables were controlled by propensity score matching method and a total of 414 patients completed 1:1 matching. Before and after the matching, the AVF dysfunction in IDWG >4% group was higher than that in IDWG≤4% group (before matching: 34.2% vs. 65.8%, χ2=5.718, P=0.017; after matching: 14.5% vs. 22.7%, χ2=4.611, P=0.032). Binary logistic regression analysis showed that age (OR=3.393, 95% CI 1.861～6.184, P<0.001), IDWG (OR=1.967, 95% CI 1.157～3.347, P=0.013), serum albumin (OR=1.759, 95% CI 1.034～2.990, P=0.037) and left ventricular mass index (OR=1.008, 95% CI 1.002～1.013, P=0.010) were the independent risk factors for AVF dysfunction. Conclusion
IDWG over 4% was an important risk factor for AVF dysfunction in MHD patients, especially in patients >60 years old, and with serum albumin <35g/L and higher left ventricular mass index.
[1] Siriopol D, Siriopl M, Stuard S, et al. An analysis of the impact of fluid overload and fluid depletion for all-cause and cardiovascular mortality [J]. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2019, 34(8): 1385-1393.
[2] Zoccali C, Moissl U, Chazot C, et al. Chronic Fluid Overload and Mortality in ESRD [J]. Journal of the American Society of Nephrology : JASN, 2017, 28(8): 2491-2497.
[3] Ok E, Asci G, Chazot C, et al. Controversies and problems of volume control and hypertension in haemodialysis [J]. Lancet (London, England), 2016, 388(10041): 285-293.
[4] Hassan M O, Duarte R, Dix-Peek T, et al. Correlation between volume overload, chronic inflammation, and left ventricular dysfunction in chronic kidney disease patients [J]. Clinical nephrology, 2016, 86 (2016)(13): 131-135.
[5] Dekker M J E, Kooman J P. Fluid status assessment in hemodialysis patients and the association with outcome: review of recent literature [J]. Current opinion in nephrology and hypertension, 2018, 27(3): 188-193.
[6] Cabrera C, Brunelli S M, Rosenbaum D, et al. A retrospective, longitudinal study estimating the association between interdialytic weight gain and cardiovascular events and death in hemodialysis patients [J]. BMC nephrology, 2015, 16: 113.
[7] 符霞. 血液透析护理实践指导手册 [M]. 北京: 人民军医出版社, 2013: 258-259.
[8] 翟丽. 实用血液净化技术及护理 [M]. 北京: 人民军医出版社, 2012: 156-158.
[9] Karava V, Benzouid C, Kwon T, et al. Interdialytic weight gain and vasculopathy in children on hemodialysis: a single center study [J]. Pediatric nephrology (Berlin, Germany), 2018, 33(12): 2329-1336.
[10] Marsenic O, Anderson M, Couloures K G. Relationship between Interdialytic Weight Gain and Blood Pressure in Pediatric Patients on Chronic Hemodialysis [J]. BioMed research international, 2016, 2016: 5972930.
[11] Hara T, Kimachi M, Akizawa T, et al. Interdialytic Weight Gain Effects on Hemoglobin Concentration and Cardiovascular Events [J]. Kidney international reports, 2020, 5(10): 1670-1678.
[12] Watanabe Y, Kawanishi H, Suzuki K, et al. Japanese society for dialysis therapy clinical guideline for "Maintenance hemodialysis: hemodialysis prescriptions" [J]. Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy, 2015, 19 Suppl 1: 67-92.
[13] 刘威, 刘昊虹, 周兵, 等. 血液透析患者透析间期体重增长与心功能关系研究 [J]. 中国医药科学, 2018, 8(12): 182-184,192.
[14] Abohtyra R, Chait Y, Germain M J, et al. Individualization of Ultrafiltration in Hemodialysis [J]. IEEE transactions on bio-medical engineering, 2019, 66(8): 2174-2181.
[15] Chang T I, Paik J, Green T, et al. Intradialytic hypotension and vascular access thrombosis [J]. Journal of the American Society of Nephrology : JASN, 2011, 22(8): 1526-1533.
[16] Premuzic V, Hudolin T, Pasini J, et al. Hypoproteinemia as a prognostic risk factor for arteriovenous fistula failure [J]. Hemodialysis international International Symposium on Home Hemodialysis, 2018, 22(1): 37-44.
[17] Spatola L, Finazzi S, Calvetta A, et al. Subjective Global Assessment-Dialysis Malnutrition Score and arteriovenous fistula outcome: A comparison with Charlson Comorbidity Index [J]. The journal of vascular access, 2019, 20(1): 70-78.
[18] 韦小红, 冯绍华, 韦昭华, 等. 维持性血液透析自体动静脉内瘘失功的主要因素分析 [J]. 广西医学, 2015, 6: 848-954.
[19] 鄢艳, 邹梦林, 黄明俊, 等. 自体动静脉内瘘使用寿命的影响因素 [J]. 中华肾脏病杂志, 2020, 36(4): 300-305.
[20] Sung S A, Ko G J, Jo S K, et al. Interleukin-10 and tumor necrosis factor-alpha polymorphisms in vascular access failure in patients on hemodialysis: preliminary data in Korea [J]. Journal of Korean medical science, 2008, 23(1): 89-93.
[21] 孙春艳, 宋利, 莫雅文, 等. 高通量透析对维持性血液透析患者自体动静脉内瘘7年次级通畅率的影响 [J]. 中国血液净化, 2020, 19(3): 187-190.
[22] Mo Y, Song L, Sun C, et al. Effect of Dumbbell Exercise on Arteriovenous Fistula in Patients Undergoing Maintenance Haemodialysis: A Prospective Randomized Controlled Trial [J]. Blood purification, 2020, 49(1-2): 16-24.
