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Investigation on the status of vascular access in maintenance hemodialysis patients in primary hospitals

  • HUI Xin ,
  • BIAN Xue-Qin ,
  • DING Hao ,
  • WU Xian ,
  • LUO Yuan ,
  • XU Fang-Fang ,
  • XU Zhi-Yu ,
  • WANG Hong-Mei ,
  • ZHANG Ya-Qi ,
  • WANG Ying ,
  • YE Hong
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  • Department of Nephrology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing 21003, China

Received date: 2023-08-29

  Revised date: 2023-11-14

  Online published: 2024-02-12

Abstract

Objective  To investigate the status of vascular access in maintenance hemodialysis (MHD) patients in primary hospitals.  Methods  This was a multi-center and cross-sectional study, which collected clinical data of the MHD patients in the hemodialysis centers of 15 primary hospitals located in 8 regions in Jiangsu and Anhui provinces from March 2023 to August 2023.  Results  A total of 650 MHD patients who met the criteria were investigated, including 342 males (52.62%) and 308 females (47.38%) with a median dialysis age of 5.48 (2.00, 8.00) years. For blood access of the first hemodialysis, non-cuffed catheter was used in 291 cases (48.10%), and autologous arteriovenous fistula (AVF) was used in 271 cases (44.79%). For current blood access of hemodialysis, autologous AVF was used in 518 cases (85.62%); rope ladder puncture technique on the AVF was used in 100 cases (19.30%), and regional puncture technique was used in 412 cases (79.54%). For blood access in patients with arteriovenous graft, rope ladder puncture technique on the graft was used in 29 cases (90.63%). Vascular stenosis, the main complication of vascular access, occurred in 177 cases (34.17%) in patients with autologous AVF and in 10 cases (31.25%) in those with arteriovenous graft.  Conclusion  The status of vascular access in MHD patients in the hemodialysis centers in primary hospitals meets the expectations of primary hospitals. However, performance of blood access should be further standardized, and personnel training should be reinforced to find out and manage vascular stenosis earlier.

Cite this article

HUI Xin , BIAN Xue-Qin , DING Hao , WU Xian , LUO Yuan , XU Fang-Fang , XU Zhi-Yu , WANG Hong-Mei , ZHANG Ya-Qi , WANG Ying , YE Hong . Investigation on the status of vascular access in maintenance hemodialysis patients in primary hospitals[J]. Chinese Journal of Blood Purification, 2024 , 23(02) : 138 -142 . DOI: 10.3969/j.issn.1671-4091.2024.02.013

References

[1] Chen TK, Knicely DH, Grams ME. Chronic Kidney Disease Diagnosis and Management: A Review. JAMA. 2019 Oct 1;322(13):1294-1304.
[2] Bello AK, Okpechi IG, Osman MA, Cho Y, Htay H, Jha V, Wainstein M, Johnson DW. Epidemiology of haemodialysis outcomes. Nat Rev Nephrol. 2022 Jun;18(6):378-395.
[3] Arasu R, Jegatheesan D, Sivakumaran Y. Overview of hemodialysis access and assessment. Can Fam Physician. 2022 Aug;68(8):577-582.
[4] Pecoits-Filho R, Okpechi IG, Donner JA, Harris DCH, Aljubori HM, Bello AK, Bellorin-Font E, Caskey FJ, Collins A, Cueto-Manzano AM, Feehally J, Goh BL, Jager KJ, Nangaku M, Rahman M, Sahay M, Saleh A, Sola L, Turan Kazancioglu R, Walker RC, Walker R, Yao Q, Yu X, Zhao MH, Johnson DW. Capturing and monitoring global differences in untreated and treated end-stage kidney disease, kidney replacement therapy modality, and outcomes. Kidney Int Suppl (2011). 2020 Mar;10(1):e3-e9.
[5] 中国医院协会血液净化中心分会血管通路工作组. 中国血液透析用血管通路专家共识(第2版)[J]. 中国血液净化,2019,18(6):365-381.
[6] 陈香美.血液净化标准操作规程(2021版)[M].北京:人民军医出版社,2020:123-125.
[7] 血液净化通路一体化管理手册/肖光辉,王玉柱主编.北京:北京航空航天大学出版社,2018.3.
[8] Pisoni RL, Zepel L, Port FK, Robinson BM. Trends in US Vascular Access Use, Patient Preferences, and Related Practices: An Update From the US DOPPS Practice Monitor With International Comparisons. Am J Kidney Dis. 2015 Jun;65(6):905-15.
[9] 王梦迪,张凌,刘鹏,等.终末期肾脏病患者初次血液透析血管通路应用的多中心调查[J].中华肾脏病杂志,2016,32(6):418—424.
[10] Pisoni RL, Arrington CJ, Albert JM, Ethier J, Kimata N, Krishnan M, Rayner HC, Saito A, Sands JJ, Saran R, Gillespie B, Wolfe RA, Port FK. Facility hemodialysis vascular access use and mortality in countries participating in DOPPS: an instrumental variable analysis. Am J Kidney Dis. 2009 Mar;53(3):475-91.
[11] Astor BC, Eustace JA, Powe NR, Klag MJ, Fink NE, Coresh J; CHOICE Study. Type of vascular access and survival among incident hemodialysis patients: the Choices for Healthy Outcomes in Caring for ESRD (CHOICE) Study. J Am Soc Nephrol. 2005 May;16(5):1449-55.
[12] Zhao X, Niu Q, Gan L, Hou FF, Liang X, Ni Z, Chen Y, Zhao J, Bieber B, Robinson B, Chen X, Zuo L. Baseline data report of the China Dialysis Outcomes and Practice Patterns Study (DOPPS). Sci Rep. 2021 Jan 13;11(1):873.
[13] 赵新菊,甘良英,牛庆雨,等. 中国血液透析患者死亡原因及特点分析-DOPPS研究的启示[J]. 中国血液净化,2022,21(2):89-93.
[14] 张尧,王霄,杜楠楠等.动静脉内瘘扣眼穿刺处内膜增生特点及停止穿刺的效果观察[J].中国血液净化,2023,22(05):396-400.
[15] 郝旭阳,张丽红,王玉柱.血液透析血管通路建立与维护新技术[J].肾脏病与透析肾移植杂志,2022,31(06):590-594.
[16] Riella MC, Roy-Chaudhury P. Vascular access in haemodialysis: strengthening the Achilles' heel. Nat Rev Nephrol. 2013 Jun;9(6):348-57.
[17] Sawo P, Moufarrej A, Sloff M, Snoeijs MG, Delhaas T, Tordoir JHM, Mees BME. The Effect of Geometric Graft Modification on Arteriovenous Graft Patency in Haemodialysis Patients: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg. 2020 Oct;60(4):568-577.
[18] Lopera Higuita M, Griffiths LG. Small Diameter Xenogeneic Extracellular Matrix Scaffolds for Vascular Applications. Tissue Eng Part B Rev. 2020 Feb;26(1):26-45.
[19] Miller PE, Carlton D, Deierhoi MH, Redden DT, Allon M. Natural history of arteriovenous grafts in hemodialysis patients. Am J Kidney Dis. 2000 Jul;36(1):68-74.
[20] KDOQI CLINICAL PRACTICE GUIDELINE FOR VASCULAR ACCESS: 2019 UPDATE[J]. American Journal of Kidney Diseases: The official journal of the National Kidney Foundation,2020,75(4 Suppl.2):S1-S164.
[21] Parisotto MT, Schoder VU, Miriunis C, Grassmann AH, Scatizzi LP, Kaufmann P, Stopper A, Marcelli D. Cannulation technique influences arteriovenous fistula and graft survival. Kidney Int. 2014 Oct;86(4):790-7.
[22] Wong B, Collister D, Muneer M, Storie D, Courtney M, Lloyd A, Campbell S, Pauly RP. In-Center Nocturnal Hemodialysis Versus Conventional Hemodialysis: A Systematic Review of the Evidence. Am J Kidney Dis. 2017 Aug;70(2):218-234.
[23] 王培莉,施素华,林巧红,等.扣眼穿刺法与绳梯穿刺法对动静脉内 瘘功能影响的 Meta分析[J].中国血液净化,2020,19(1):65-69.
[24] 陶玲玲,曾财花,殷鹭等.钝针扣眼穿刺对血液透析患者动静脉内瘘并发症的影响[J].实用临床医学,2022,23(05):70-72+100.
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