Objective To analyze the risk factors for hemodialysis access-induced distal ischemia (HAIDI) syndrome. Methods This study enrolled 70 end-stage renal disease patients undergoing hemodialysis for the first time in Department of Nephrology, Rongxian People's Hospital from May 2025 to May 2022. According to the presence or absence of HAIDI syndrome, they are divided into HAIDI group (n=15) and the non-HAIDI group (n=55). Clinical data were collected and compared between the two groups. Univariate analysis was conducted to find out the potential risk factors for HAIDI syndrome. Binary logistic regression was used to quantify the potential risk factors. Results Univariate analysis showed that the ratios of≥60 years of age, female, hypertension history, diabetes, vasculitis, systemic lupus erythematosus, dialysis age more than one year, arteriovenous fistula (AVF) graft, and autologous AVF using brachial artery were higher in HAIDI group than in non-HAIDI group (χ2/t=4.419, 4.272, 4.904, 6.360, 10.972, 7.231, 5.657 and 18.670 respectively; P=0.036, 0.039, 0.027, 0.012, 0.001, 0.007, 0.017 and <0.001 respectively). Binary logistic regression analysis showed that older age, female, hypertension history, diabetes history, vasculitis, systemic lupus erythematosus, longer dialysis age, AVF graft, and AVF of higher position were the risk factors for HAIDI (OR=0.286, 3.353, 0.274, 0.224, 0.051, 0.074, 4.111, 0.055 and 0.049 respectively; 95% CI:0.086～0.954, 1.030～10.920, 0.084～0.895, 0.066～0.755, 0.005～0.500, 0.007～0.775, 1.223～13.818, 0.010～0.303 and 0.007～0.321 respectively; P=0.042, 0.045, 0.032, 0.016, 0.011, 0.030, 0.022, 0.001 and 0.002 respectively). Conclusion Age, sex, hypertension, diabetes, vasculitis, systemic lupus erythematosus, dialysis age and vascular access type are the risk factors for HAIDI. Prevention and control measures focusing on the patients with these risk factors will help reduce the occurrence of HAIDI syndrome.
CAO Xue-Ling
,
LIAO Jie
,
YU Li-Li
. Risk factors for distal limb ischemia syndrome caused by vascular access[J]. Chinese Journal of Blood Purification, 2024
, 23(03)
: 219
-222
.
DOI: 10.3969/j.issn.1671-4091.2024.03.014
[1] 赵帅,朱岩岩,李合华,等.远端肢体缺血后处理对急性脑梗死患者神经功能缺损症状恢复的影响[J].心脑血管病防治, 2021, 21(3):225-229.
[2] 张婷婷,王惠迪,蒋其萍,等.远端肢体缺血处理对脑缺血后神经保护作用的研究进展[J].徐州医学院学报, 2021, 41(1):71-75.
[3] 陈彬,张永军,陶建平,等.远端肢体缺血预适应对择期PCI病人围术期心肌损伤及远期心功能的影响[J].中西医结合心脑血管病杂志, 2021, 19(17):2964-2966.
[4] 刘潇强,陈荣波,方敬念,等.肢体远端缺血后适应在急性脑梗死患者血管再通治疗后的临床应用[J].中国医师进修杂志, 2022, 45(6):517-520.
[5] 陈彬,胡雨,陶建平,等.远端肢体缺血预处理对AMI患者的心肌保护作用及对远期预后的影响[J].心血管康复医学杂志, 2022, 31(1):19-22.
[6] 张文福,梁伟东,钟茂林,等.肢体远端缺血后处理对脑缺血再灌注损伤的保护机制研究进展[J].局解手术学杂志, 2021,30(10):907-912
[7] 郑伟,宋晓雪,严翔,等.人工远端肢体缺血再灌注对APAP诱导小鼠肝损伤的保护作用研究[J].现代检验医学杂志, 2021, 36(4):60-63,110.
[8] 顾明明,谭焱,张瑜,等.远端肢体缺血预处理对大鼠心脏骤停后肠道屏障功能的影响[J].华南国防医学杂志, 2021,35(3):164-167, 175.
[9] 臧金鹏,刘建浩,韩丹.眼针"醒神通经"技术治疗中风后肢体远端运动障碍的临床研究[J].四川中医, 2022,40(6):184-187.
[10] 高江平,李慧,左尚维,等.股深动脉及其流入道血管重建治疗严重肢体缺血阶段血栓闭塞性脉管炎九例效果分析[J].中华外科杂志, 2021, 59(12):980-986.
[11] Singer E , Garcia T , Stover S .How does bone strain vary between the third metacarpal and the proximal phalangeal bones of the equine distal limb?[J].Journal of Biomechanics, 2021, 123(7):110455.
[12] Chang M D , O'Brien-Irr M , Montross B ,et al.Statins Save Limbs in Patients With Chronic Limb Threatening Ischemia and End Stage Renal Disease[J].Journal of Vascular Surgery, 2021, 74(3):284.
[13] 赖艳红,杨涛.血液透析通路引起的肢体远端缺血征的研究进展[J].中国血液净化, 2017, 16(001):57-59.
[14] 赖艳红,杨涛,王玉柱.光电容积描记法在血液透析通路引起的肢体远端缺血征中的应用——附一例报告[J].中华肾脏病杂志,2017,33(3):226-226
[15] 赖艳红,杨涛,王玉柱.血液透析通路引起的肢体远端缺血征的诊治研究进展[J].中华肾脏病杂志,2017,33(1):73-76
[16] 赵利军,门秀丽,董淑云,等.骨骼肌缺血预适应对肢体缺血再灌注后心肌的远端保护作用[J].中国医科大学学报, 2008, 37(002):168-170.
[17] 李娟,涂晓文.动静脉内瘘引起的肢体远端缺血征1例及文献复习[J].中国中西医结合肾病杂志, 2019, 20(7):640-641.
[18] 王玉柱.透析通路相关性缺血综合征[J].临床肾脏病杂志, 2012, 12(7):295-296.
[19] Siu M , Lin A , Narvaez V ,et al.Analysis of Outcomes in Acute Limb Ischemia Patients during COVID-19 State of Emergency in Western Massachusetts[J].Journal of Vascular Surgery, 2021, 73(3):38-39.
[20] Tang W , Tonna J E , Smith B K ,et al.Arterial Duplex Ultrasound Criteria for Predicting Limb Ischemia and Amputation Among Patients Undergoing Femoral Cannulation for Extracorporeal Membrane Oxygenation[J].Journal of Vascular Surgery, 2021, 74(3):269.
[21] Patil A , Shafi I , Lakhter V ,et al.INCIDENCE AND PREDICTORS OF ACUTE LIMB ISCHEMIA IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION - INSIGHT FROM NATIONAL READMISSION DATABASE[J].Journal of the American College of Cardiology, 2021, 77(18):1083.
