探討南台灣血液透析患者血管通路存活率之危險因子

Investigation of the Risk Factors of Vascular Access Survival in Hemodialysis Patients in Southern Taiwan

血管通路功能喪失會使血液透析病患的罹病率、死亡率及醫療費用增加，但在末期腎臟病高盛行率的南台灣卻鮮少探討。本研究目的為探討南台灣血液透析病患血管通路功能存活率的危險因子。研究中收集了南台灣一間醫院內所有常規血液透析病患，共225位病人。觀察患者自動靜脈血管通路建立到初次的血管通路功能喪失，運用Cox迴歸統計方法並校正人口學及相關疾病來分析動靜脈血管通路功能喪失的危險因子。經由多變項分析，人工血管與血管通路功能喪失呈現有意義相關(Hazard ratio：2.384；p < 0.001)。進一步分析使用自體動靜脈唱管的患者，發現糖尿病與自體動靜脈唱管的功能喪失呈有意義相關(Hazard ratio：2.430；p = 0.001)。本研究結果顯示人工血管會顯著的增加血管通路功能喪失的機率，以及糖尿病為自體動靜脈唱管功能喪失的危險因子。本研究結果支持臨床血管使用應以自體唱管為優先考量，並加強對糖尿病病患的動靜脈唱管照護衛教。

Vascular access failure (VAF) is associated with increased morbidity and mortality in hemodialysis patients. However, it is seldom studied in southern Taiwan, an area with high prevalence of end-stage renal disease. The aim of this study is to evaluate the risk factors for vascular access survival in a hospital. All 225 routine hemodialysis patients in one regional hospital were included in the study. The study subjects were observed from arteriovenous access creation until the first episode of VAF. The relative VAF risk was analyzed by Cox-regression methods with adjustments for demographic and comorbid conditions. Results: After the multivariate analysis, vascular access type of arteriovenous graft (AVG) was positively associated with VAF (hazard ratio [HR]= 2.384). We further analyzed the subgroup patients with arteriovenous fistula (AVF) and found that diabetes mellitus (DM) was significantly correlated with AVF failure in the multivariate analysis (HR= 2.430). Our findings show that vascular access type of AVG was significantly associated with a poor vascular access outcome, and DM was a risk factor for AVF failure. These results support clinical guidelines that recommend superior choice of a native fistula and address the importance of AVF care in the diabetic hemodialysis patients.