目的 本研究旨在探讨血液透析用血管通路并发症对维持性血液透析(maintenance hemodialysis,MHD)患者预后的影响。 方法 回顾性分析2009年1月─2022年10月成都医学院第一附属医院MHD患者血管通路情况进行队列研究，收集患者的人口统计学、临床特征、血管通路使用和并发症发生资料，以及患者的生存数据。分析患者的并发症发生情况，根据是否发生通路并发症将患者分为无并发症组(n=324)和有并发症组(n=176)，分析血管通路并发症对MHD患者预后的影响，并通过亚组分析评估研究结果的一致性。以全因死亡作为研究的终点事件。 结果 共纳入并评估MHD患者500例，其中发生通路并发症患者176例(35.5%)。随访期间82例(16.4%)患者发生死亡。多因素Logistic回归分析结果显示：与无并发症组患者相比，有并发症组患者的全因死亡风险增加117.8%(HR=2.178，95% CI：1.232～3.860，P=0.007)。亚组分析结果显示：在不同年龄(Z =-1.689，P=0.091)、体质量指数(Z =-1.357， P=0.175)及不同血管通路类型(Z=0.863，P=0.172)患者、女性患者(Z=2.834，P=0.005)以及无糖尿病(Z =-2.347，P=0.019)的患者发生血管通路并发症对MHD患者全因死亡风险的预测作用显著。 结论 是否发生通路并发症可以用于筛选高死亡发生风险的MHD患者。在临床实践过程中，发生过通路并发症的患者需要得到更多的关注。
Objective This study evaluated the impact of vascular access complications on outcomes in maintenance hemodialysis (MHD) patients. Methods We retrospectively analyzed the data of a vascular access cohort from Jan 2009 to Oct 2022 in our institution. Demographic, clinical, vascular access, vascular access complication, and survival data were collected. Patients were grouped based on complication status: no complication group (n=324) and complication group (n=176). All-cause mortality was the primary endpoint. Multivariate logistic regression and subgroup analyses were used to assess the relationship between vascular access complications and mortality. Results Among 500 MHD patients, 176 (35.5%) developed vascular access complications. During the follow-up period, 82 (16.4%) died. Multivariate logistic regression found that the all-cause mortality risk in complication group increased to 117.8% of the risk in no complication group (HR=2.178, 95% CI: 1.232～3.860, P=0.007). Subgroup analyses demonstrated that age (Z=-1.689, P=0.091), BMI (Z=-1.357, P=0.175), vascular access type (Z=0.863, P=0.172), female (Z=2.834, P=0.005) and non-diabetic were the factors significant influencing the prediction of all-cause mortality by vascular access complications in MHD patients. Conclusion Vascular access complications may be used to identify the MHD patients at a high risk of mortality that warrants intensive surveillance.
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