| Research Purpose:To investigate the influencing factors of arteriovenous fistula failure in maintenance hemodialysis patients,and to provide a reference for establishing a strategy to extend the use time of arteriovenous fistula.Research Methods:Meta-analysis was used to combine the results of related research on the factors affecting the arteriovenous fistula failure in maintenance hemodialysis patients.We searched ten databases including Cochrane Library,Pubmed,Embase,Ovid,Web of science,CINAHL,CBM,CNKI,VIP and Wanfang.Study types including cohort study and case-control study on the influencing factors of arteriovenous fistula failure in patients with maintenance hemodialysis until July 2019,and references for eligible studies,subject-related studies and reviews are retrospected.Documents were managed with NoteExpress software,and the quality of the documents was evaluated with the JBI evidence-based health care centre in Australia.Two reviewers independently searched,screened the documents,extracted the data,and evaluated the quality of the documents.After cross-checking,statistical analysis was performed using RevMan 5.3 and Stata12.0 software.Research Results:In the end,34 cohort studies and 36 case-control studies were included.Due to the different combined effect values of the two types of studies,they were combined respectively,and the sixteen influencing factors were divided into four categories.The results of meta-analysis are as follows:1.Nursing-related factorsThe risk of fistula loss was higher in maintenance hemodialysis patients with hemostatic compression for 30 min after dialysis than in patients with hemostatic compression for less than30 min after dialysis [OR(95%CI)=2.78(1.60~4.80),P<0.05].The risk of fistula loss in maintenance hemodialysis patients with hypotension in dialysis was higher than that in patients without hypotension in dialysis [OR(95%CI)=3.27(2.30~4.64),P<0.05].Statin drugs in patients with maintenance hemodialysis fistula in the risk of loss is lower than patients who were not taking statins [RR(95%CI)= 0.88(0.84 ~ 0.92),P < 0.05].Oppression hemostasis time of 30 min afterdialysis and dialysis hypotension are the risk factors of autogenous arteriovenous fistula failure in patients with maintenance hemodialysis,and taking statins is its protection factor.2.Dialysis-related factorsThere was no significant difference in the risk of fistula loss between maintenance hemodialysis patients with high fistula and patients with low fistula [RR(95%CI)=1.12(0.85-1.48),P > 0.05],[OR(95%CI)=1.16(0.73~1.83),P > 0.05].There was no significant difference in the risk of fistula failure in maintenance hemodialysis patients with end-to-end anastomosis and non-end-to-end anastomosis [OR(95%CI)=0.73(0.53~1.01),P > 0.05].After sensitivity analysis,the conclusion [OR(95%CI)=0.69(0.48~0.98),P < 0.05] was different from the original conclusion,with unstable results.It may have something to do with the inconsistenCIes in the comparison methods of the study Huijbregts 2007,and due to the small number of studies included in this factor,the results still need to be verified by further studies.There was no significant difference in the risk of fistula loss between patients with ipsilateral catheterization history and those with contralateral catheterization history [RR(95%CI)=1.38(0.76~2.51),P >0.05].The risk of loss of fistula in patients with arteriovenous fistula before hemodialysis is lower than that in patients with fistula after hemodialysis [RR(95%CI)=0.77(0.65~0.91),P < 0.05].The establishment of fistula before hemodialysis is a protective factor for failure of arteriovenous fistula in patients with maintenance hemodialysis.The result of the sensitivity analysis is stable and reliable.3.Individual factorsAge was assoCIated with fistula loss [RR(95%CI)=1.01(1.00~1.02),P < 0.05],and the risk of fistula loss in elderly patients was higher than that in younger patients [RR(95%CI)=1.37(1.20 ~1.57),P < 0.05].The risk of fistula loss in female patients was higher than that in male patients[RR(95%CI)=1.19(1.11~1.28),P < 0.05],[OR(95%CI)=1.38(1.21~1.58),P < 0.05].The risk of fistula loss in smoking patients was higher than that in non-smoking patients[RR(95%CI)=1.50(1.19 ~ 1.90),P < 0.05].Patients with hypercoagulability had a higher risk of fistula loss [OR(95%CI)=4.21(1.93 ~ 9.18),P < 0.05].The risk of fistula loss in hemodialysis patients with arterial calCIfication was higher than that in patients without arterial calCIfication[RR(95%CI)=1.53(1.28 ~ 1.83),P < 0.05].Advanced age,female,smoking,hypercoagulability and arterial calCIfication are risk factors for loss of arteriovenous fistula in maintenancehemodialysis patients.The result of the sensitivity analysis is stable and reliable.4.Comorbid factorsThe risk of fistula loss in patients with diabetes was higher than that in patients without diabetes[RR(95%CI)=1.21(1.19~1.24),P<0.05],[OR(95%CI)=2.28(1.62~3.20),P < 0.05].The risk of fistula loss in patients with hypertension was higher than that in patients without hypertension[RR(95%CI)=1.27(1.03~1.56),P<0.05],[OR(95%CI)=1.70(1.09~2.64),P < 0.05].There was no significant difference in the risk of fistula loss between patients with coronary artery disease and those without coronary artery disease [RR(95%CI)=1.02(0.86 ~ 1.22),P > 0.05],[OR(95%CI)=1.56(0.95 ~ 2.58),P > 0.05].The risk of fistula loss in patients with peripheral vascular disease was higher than that in patients without peripheral vascular disease[RR(95%CI)=1.31(1.12~1.53),P < 0.05],[OR(95%CI)=2.62(1.23~5.59),P < 0.05].Concomitant diabetes,concomitant hypertension and concomitant peripheral vascular disease are risk factors for the failure of autologous arteriovenous fistula in patients with maintenance hemodialysis.The result of the sensitivity analysis is stable and reliable.Research Conclusion:This study used a meta-analysis method to explore the 16 influencing factors related to the failure of autologous arteriovenous fistula in maintenance hemodialysis patients,including age,gender,history of diabetes,history of hypertension,smoking,and peripheral vascular disease,compression hemostasis time after dialysis,hypotension during dialysis,hypercoagulable state of the patient,arterial calcification,taking statins,AVF settling time are related to arteriovenous fistula failure in maintenance hemodialysis patients,elderly,female,history of diabetes,History of hypertension,smoking,and peripheral vascular disease,compression hemostasis time ?30min after dialysis,hypotension during dialysis,hypercoagulable state,and arterial calcification are its risk factors.Taking statins,the establishment of AVF before hemodialysis is its protective factor.The position of fistula,the history of ipsilateral catheterization and coronary artery disease have nothing to do with the fistula failure.The relationship between vascular anastomosis and arteriovenous fistula failure in maintenance hemodialysis patients is unstable after sensitivity analysis and needs further study. |
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