TITLE: Survival of Vascular Accesses in Chronic Hemodialysis Patients

BACKGROUND/AIMS: Vascular access (VA) is the highest risk factor for blood infections, hospitalization, and mortality of patients undergoing hemodialysis (HD). The risk of mortality while using a catheter is greater than that while using grafts. The objective of this article is to know the survival rate in relation to the type of VA.

METHODS: A retrospective cohort of HD patients was studied. The data gathered included age, gender, first VA at the surrogate site, days between the first and second access, number of accesses, and anatomical site of VA placement. Mean differences were estimated using χ2 or Student's t test. Survival was calculated using the Kaplan-Meier curves and included in tables. Statistical significance was established as p < 0.05. The statistical computer software package SPSSw v25 was used for the analysis.

RESULTS: A total of 896 patients were included with a mean age of 47.88 years (SD ± 16.52), the duration of the first VA was 398.81 days (±565.79), the mean number of VAs used was 2.26 (±1.15), and the median time undergoing HD was 728.73 days. The duration of catheter placement was 330.42 days, and 728.60 days for fistula use (p = 0.001). The mean number of days of renal replacement was 611.59 days for catheter and 1,495.25 days for internal arteriovenous fistula (IAVF) patients (p = 0.001).

CONCLUSIONS: The survival of the initial VA is greater for the IAVF, followed by the tunneled catheters and the lowest by the non-tunneled catheters, which continue to be frequently used in our setting.

SOURCE： Santos-Ontiveros A, Reyes-Sánchez I, Hernández-Luevano E, et al. Survival of Vascular Accesses in Chronic Hemodialysis Patients[J]. Blood Purif, 2020:1-8. DOI: 10.1159/000512119.

背景/目的：血管通路(VA)是血液透析(HD)患者血液感染、住院和死亡的最高危险因素。使用导管的死亡率高于使用移植物的死亡率。本文的目的是了解VA类型与生存率的关系。

方法：对维持性血液透析患者进行回顾性队列研究。收集的数据包括年龄，性别，替代部位的首次VA，第一次和第二次通路建立之间的天数，通路建立的次数，VA建立的解剖位置。用χ2或t-检验估计均数差异。存活率是使用Kaplan-Meier曲线计算的，并包含在表格中。差异有统计学意义：P<0.05。用计算机软件包SPSSw V25进行统计分析。

结果：入选患者896例，平均年龄47.88岁(SD±16.52)，首次VA持续时间398.81天(±565.79天)，平均通路建立次数2.26次(±1.15次)，接受透析的中位时间为728.73天。导管放置时间为330.42天，内瘘使用时间为728.60天(p=0.001)。导管使用的平均天数为611.59天，动静脉内瘘的平均天数为1495.25天 (p = 0.001)。

结论：IAVF的初始VA存活率较高，其次是隧道导管，而非隧道导管的存活率最低，在我们中心仍然经常使用非隧道导管。

启发：从生存率方面，再次强调“优先选择自体动静脉内瘘”。