Solafa S M Salih, Khalid O Mohamed, Abdalla O O Mohamedali, Ahmed A O Mahmoud, Duaa A S Ibrahim, Khadeja F Abdallah, Mohamed S K Salih, Aseel E B Abdhameed, Nehal S A Salih, Khalid S K Salih, Samia I E Mursal, Ahmed S E E Abdelrahman, Ayoub A B Mohamed, Yusra E A Elmobashir, Amgad I A Mohamed, Sagad O O Mohamed
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These factors should be considered from a patient safety perspective and included in the shared decision-making process with patients who are candidates for arteriovenous fistula surgery. Optimizing these factors may enhance fistula maturation and reduce the need for repeat vascular access procedures. 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引用次数: 0
摘要
背景：血液透析是肾脏替代治疗中最普遍的方式。血液透析的持久性及其质量取决于持续可靠地进入患者血管系统。在这篇系统综述中，我们对原发性动静脉瘘失败的预测因素进行了全面的分析。方法：系统检索PubMed、Web of Science、ScienceDirect和WHO虚拟健康图书馆区域门户网站，从数据库建立到2025年3月。搜索词包括“动静脉瘘”、“衰竭”、“血液透析”、“终末期肾病”和“危险因素”的组合。四名审稿人独立筛选标题和摘要，并根据预定义的纳入标准评估全文。如果研究检查了成人血液透析患者原发性动静脉瘘失败的危险因素，则该研究是合格的。结果：系统评价共纳入38项研究。早期动静脉瘘失败与瘘管位置远端、动脉直径小、静脉直径小、血清白蛋白水平低、女性、糖尿病、收缩压和舒张压降低显著相关。结论：本系统综述确定了终末期肾病（ESRD）血液透析患者早期动静脉瘘失效的几个关键危险因素。应从患者安全的角度考虑这些因素，并将其纳入与候选动静脉瘘手术患者的共同决策过程中。优化这些因素可以促进瘘管成熟，减少重复血管通路手术的需要。然而，认识到ESRD患者的一些危险因素可能不易改变，临床医生应平衡优化努力与建立血管通路的紧迫性。
Predictors of early arteriovenous fistula failure in patients with end stage renal disease on hemodialysis: a systematic review and meta-analysis.
Background: Hemodialysis is the most prevalent modality of renal replacement therapy. The durability of hemodialysis and its quality depend on consistent and reliable access to the patient's vascular system. In this systematic review we provide a comprehensive analysis of the predictors of primary arteriovenous fistula failure.
Methods: A systematic search was conducted in PubMed, Web of Science, ScienceDirect, and the WHO Virtual Health Library Regional Portal from database inception through March 2025. Search terms included combinations of 'arteriovenous fistula', 'failure', 'hemodialysis', 'end-stage renal disease', and 'risk factors'. Four reviewers independently screened titles and abstracts, with full texts assessed according to predefined inclusion criteria. Studies were eligible if they examined risk factors for primary arteriovenous fistula failure in adult patients on hemodialysis.
Results: A total of 38 studies were included in the systematic review. Early arteriovenous fistula failure was significantly associated with a distal location of the fistula, small arterial diameter, small vein diameter, low serum albumin level, female gender, diabetes mellitus, and decreased systolic and diastolic blood pressure.
Conclusion: This systematic review identified several key risk factors for early arteriovenous fistula failure in patients with end-stage renal disease (ESRD) undergoing hemodialysis. These factors should be considered from a patient safety perspective and included in the shared decision-making process with patients who are candidates for arteriovenous fistula surgery. Optimizing these factors may enhance fistula maturation and reduce the need for repeat vascular access procedures. However, recognizing that some risk factors may not be readily modifiable in ESRD patients, clinicians should balance optimization efforts with the urgency of establishing vascular access.
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