基于国民健康保险服务数据库的韩国老年人永久性血管通路的结果评估

IF 1.2 4区 医学 Q3 UROLOGY & NEPHROLOGY
Hyangkyoung Kim, Hoon Suk Park, Tae Hyun Ban, Seung Boo Yang, Young joo Kwon, the vascular access working group of the Korean Society of Dialysis Access
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引用次数: 0

摘要

由于近一半开始进行血液透析(HD)的终末期肾病(ESKD)患者年龄超过65岁(通常定义为老年人),因此即使在≥65岁的HD患者中,瘘管优先策略也存在争议。方法对2008年至2019年韩国国民健康保险服务数据库中41989例老年(≥65岁)HD患者进行回顾性分析,以确定其临床特征和结局。比较动静脉瘘(AVF)和动静脉移植物(AVG)的血管通路(VA)通畅度、相关危险因素及患者生存率。结果老年AVF组(n = 28,467)的原发性、原发性辅助和继发性通畅率均高于老年AVG组(n = 13,522) (p值均为<0.001)。老年AVF组患者生存率也高于老年AVG组(p < 0.001)。在多种结局的多变量Cox回归分析中,AVG (vs. AVF)被确定为全因死亡的危险因素(校正危险比[HR]: 1.307;95%置信区间[CI]: 1.272-1.343;p < 0.001),原发性通畅(调整后HR: 1.745;95% ci: 1.701-1.790;p < 0.001),原发性辅助通畅(调整后风险比:2.163;95% ci: 2.095-2.233;p < 0.001)和继发性通畅(调整后HR: 3.718;95% ci: 3.533-3.913;p < 0.001)。结论:我们的研究表明,对于老年(≥65岁)韩国ESKD患者,应强烈考虑AVF作为HD的永久性VA。ESKD患者产生AVF的年龄限制应该向上调整。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Evaluation of outcomes with permanent vascular access in an elderly Korean population based on the National Health Insurance Service database

Introduction

As nearly half of patients with end-stage kidney disease (ESKD) who initiate hemodialysis (HD) are over 65 years old (commonly defined as elderly), the fistula first strategy is controversial even in HD patients ≥65 years.

Methods

In Korea's National Health Insurance Service database from 2008 to 2019, 41,989 elderly (≥ 65 years) HD patients were retrospectively reviewed to identify their clinical characteristics and outcomes. Vascular access (VA) patencies, risk factors associated with patencies and patient survival between arteriovenous fistula (AVF) and arteriovenous graft (AVG) were compared.

Results

Elderly AVF group (n = 28,467) had superior primary, primary assisted, and secondary patencies than elderly AVG group (n = 13,522) (all p values are <0.001). Patient survival was also better in the elderly AVF group than in the elderly AVG (p < 0.001). In multivariate Cox regression analyses for diverse outcomes, AVG (vs. AVF) was identified as a risk factor for all-cause mortality (adjusted hazard ratio [HR]: 1.307; 95% confidence interval [CI]: 1.272–1.343; p < 0.001), primary patency (adjusted HR: 1.745; 95% CI: 1.701–1.790; p < 0.001), primary-assisted patency (adjusted HR: 2.163; 95% CI: 2.095–2.233; p < 0.001), and secondary patency (adjusted HR: 3.718; 95% CI: 3.533–3.913; p < 0.001).

Conclusion

Our study demonstrated that as a permanent VA for HD, AVF should be strongly considered in elderly (≥ 65 years) ESKD Korean patients. The age limit for AVF creation in ESKD patients should be adjusted more upward.

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来源期刊
Hemodialysis International
Hemodialysis International UROLOGY & NEPHROLOGY-
CiteScore
2.50
自引率
0.00%
发文量
58
审稿时长
6-12 weeks
期刊介绍: Hemodialysis International was originally an annual publication containing the Proceedings of the International Symposium on Hemodialysis held in conjunction with the Annual Dialysis Conference. Since 2003, Hemodialysis International is published quarterly and contains original papers on clinical and experimental topics related to dialysis in addition to the Annual Dialysis Conference supplement. This journal is a must-have for nephrologists, nurses, and technicians worldwide. Quarterly issues of Hemodialysis International are included with your membership to the International Society for Hemodialysis. The journal contains original articles, review articles, and commentary to keep readers completely updated in the field of hemodialysis. Edited by international and multidisciplinary experts, Hemodialysis International disseminates critical information in the field.
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