Survival Analysis Of Arteriovenous Fistula In Maintenance Hemodialysis Patients With Diabetic Kidney Disease

Background At present,The global incidence of diabetes among adults is estimated at 6.4%,which is expected to increase to 7.7% by 2030,mainly in developing countries.Diabetic kidney disease(DKD)is a common complication of diabetes mellitus and an important reason for patients to begin hemodialysis.A long-term effective and functional vascular pathway is a prerequisite for hemodialysis.AVF has many advantages,such as high patency rate,low medical cost,less complications and so on.It is still the first choice for hemodialysis patients to establish vascular pathway.However,during hemodialysis,many factors may lead to the loss of AVF function,especially in patients with diabetic kidney disease,the incidence of atherosclerosis and calcification is significantly increased,and the risk of AVF dysfunction is increased.To understand the life span of internal fistula and the related factors of internal fistula dysfunction in diabetic nephropathy patients has important guiding significance for prolonging the use time of AVF in these patients.there are few factors related to DKD end-stage nephropathy patients using AVF life and internal fistula dysfunction so far.Objective To investigate the service life of AVF in DKD hemodialysis patients,and to analyze the risk factors of AVF service life in DKD hemodialysis patients.In order to prolong the service life of AVF in such patients,reduce the medical expenditure and reduce the disease burden of patients.Methods Chose 160 patients with DKD underwent standard internal fistula(forearm radial arterio-cephalic venous fistula)and maintained hemodialysis with internal fistula inthe third people's Hospital of Hainan Province,from December 2010 to March2017.The clinical data of all patients were collected,and the first internal fistula failure was used as the observation end point.Kaplan-Meier method was used to analyze the influencing factors of arteriovenous fistula service life and AVF dysfunction in patients with DKD.Cox regression analysis was used to study the related factors of AVF service life and the influence of AVF on cardiac function.Results1 According to the function of internal fistula,the subjects were divided into two groups: the dysfunction group and the open group.The results showed that the percentage of patients with hypertension and coronary heart disease in the dysfunction group was significantly higher than that in the open group.Compared with the open group,the glycosylated hemoglobin,platelet and phosphorus of triglyceride,PTH,CRP,were significantly higher than those in the dysfunction group,while albumin was significantly lower than that in the open group.2 There were 45 patients with internal fistula dysfunction and 6 patients with early dysfunctions,including 3 cases of dysmaturation of internal fistula and 3 cases of thrombosis.The causes of thrombosis included hypotension in 2 cases and accidental compression in 1 case.There were 39 cases of late failure,including 30 cases of thrombosis,7 cases of vascular stenosis,1 case of infection and 1 case of ruptured hemorrhage of aneurysm,among which 24 cases were caused by hypotension,4cases by vascular stenosis and 2 cases by accidental compression.It is suggested that hypotension is a direct factor that leads to thrombosis and further loss of work of internal fistula.3 Kaplan-Meier method was used to analyze the survival of AVF.The results showed that the median survival time of internal fistula was 205 ±12.072 days.The factors influencing the service life of internal fistula were analyzed by Kaplan-Meier method.The results showed that hypertension,age,glycosylated hemoglobin,platelet,serum albumin,triglyceride,serum phosphorus and serum CRP were the risk factors of AVF service life.At the same time,the median survival time of patients with larger fistula diameter was longer than that with smaller fistula.4 The effects of Cox regression analysis on the life span of AVF were analyzed.The results showed that the independent risk factors of AVF dysfunction included fistula diameter,hypertension,glycated hemoglobin,blood phosphorus and CRP.5 The effects of AVF on cardiac function in diabetic nephropathy patients showed that the cardiac output(CO)and cardiac index(CI)were significantly increased in both groups compared with that before operation.Left atrial diameter(LAD),left ventricular inner diameter(LVD)and left ventricular diastolic volume(LVDV)were significantly enlarged after operation.In addition,in the internal fistula group,the above indexes of patients with internal fistula ? 750 ml / min were significantly higher than those in patients with internal fistula blood flow less than 750ml/min.Conclusion In this study,the median life span of AVF in DKD patients with AVF dysfunction was 189 ±10.667 days,which was significantly lower than that in non-diabetic patients.glycosylated hemoglobin ? platelet ? albumin ? triglyceride ? serum phosphorus?CRP?the operation time of internal fistula?the diameter of fistula and the blood flow of internal fistula were risk factors for AVF dysfunction.The Cox regression analysis showed that the independent risk factors of AVF dysfunction included fistula diameter,hypertension,glycated hemoglobin,blood phosphorus and CRP.At the same time,hypotension is a direct factor that leads to thrombosis and loss of work from internal fistula.After arteriovenous fistula,there is a potential impact on cardiac structure and function.Therefore,more attention should be paid to the use of internal fistula in patients with diabetes,and intervention measures should be taken in response to the above risk factors,which may effectively prevent or delay the occurrence of AVF dysfunction and prolong the service life of AVF.Ensure the patient's hemodialysis goes smoothly,at the same time save patient medical treatment to point out.