Multicenter Study Of Vascular Access In Hemodialysis Patients In Ji Nan

ObjectiveTo clarify the selection,establishment and use of vascular access in hemodialysis patients in Jinan,analyze and compare the complications of different vascular accesses,and provide some guidance for clinical rational selection.MethodsBy organizing the blood purification center contacts of various hospitals in Ji Nan,unified questionnaires were distributed to the patients in the corresponding hospitals to collect medical history and record data,and supplementary verification was made through inquiring medical records.The main data collected included basic information:name,gender,age,Hospital,contact information,ID number,time of first renal failure,etc.;Case information:type of primary disease,time of each dialysis,dialysis blood flow,dialysis frequency,dialysis age,etc.;information on vascular access:including establishing blood vessels The hospital,the type of vascular access,the time of establishment,the time of use,the material of the access,the location of the vascular access,the site of autologous arteriovenous fistula,the choice of blood vessels,the way of vascular anastomosis,the complications during use,and the reasons for loss of function Etc.,and other specific information collection of vascular access changes.The data was entered into the EXCELL form and statistical analysis was performed with SPSS 22.0.ResultsThere were totally 1390 patients were eligible for the study,of which 805 were male(57.9%)and 585 were female(41.9%);the youngest was 16 years old and the oldest was 92 years old.Among them,the patients were mainly distributed between 40-70 years old,accounting for up to 75.1%;among all the primary diseases,diabetic nephropathy was the most common(32.1%),chronic nephritis accounted for 24.0%,hypertensive kidney arteriosclerosis accounted for21.2%.Other causes included chronic interstitial nephritis,polycystic kidney disease,and obstructive nephropathy.When the vascular access was first selected,the non-tunneled catheter(NTC)had the largest specific gravity(48.7%).followed by AVF(38.9%).AVF accounted for the highest proportion in the second and third vascular access.Other access types such as direct arteriovenous puncture and arteriovenous graft(AVG)accounted for a relatively low proportion.Among the first vascular access pathways,512 patients selected AVF,of which 119 had vascular access changes,accounted for 23.2%,and 65 patients selected TCC.Among them,22 patients changed vascular access,accounted for 33.9%.There were 641 patients selected NTC,of whom 592 had pathway changes,account for 92.4%.Among the patients with NTC for the first time,540 patients changed their access to autologous artenovenous fistula,accounted for 91.2%.At present,in the overall maintenance hemodialysis patients,the number of patients with autologous arteriovenous fistula was 1134,and the overall AVF use rate was 82.4%.Further analysis found that patients with age less than 60 years had higher AVF use rate when they built the hemodialysis channel for the first time.The proportion of people with diabetes in the first way was AVF,which was 23.7%,which was significantly lower than that of non-diabetics.The main anastomosis site of AVF was the radial artery-cephalic vein,and the anastomosis was mainly end-to-side anastomosis and end-to-end anastomosis.The main choices for cardiac vein cannulation were the internal jugular vein and femoral vein.Current statistics showed that blood flow during dialysis was mainly concentrated in 200ml/min-250ml/min,which accounted for 77.4%.The current dialysis frequency of hemodialysis patients was mostly 4h*3 times a week.Among the first patients with AVF,the incidence of complications was 15.6%.In the second patient with AVF,the complication rate was 16.8%.The main complications were thrombosis,insufficient blood flow,infection and swelling.Hand syndrome.The incidence of complications of NTC was 20.3%.The most important complication was insufficient blood flow,followed by thrombosis,infection,and shedding.The complication rate of TCC was 20.0%,including insufficient blood flow,infection,and thrombosis.Overall,the incidence of complication of AVF was significantly lower than that of catheter.Conclusion1.The primary disease of maintenance hemodialysis patients in Jinan was mainly diabetic nephropathy The overall use rate of AVG was very low.The first time of opening was far from the standard recommended by the guidelines,but the use of maintenance dialysis pathways generally met the guidelines.2.Among all dialysis patients,patients with primary disease with diabetes had significantly lower AVF use than non-diabetic patients,and the older patients had lower initial AVF built rates.3.The main choice of vascular anastomosis in the AVF fistula wa the radial artery-cephalic vein,and the anastomosis was mainly end-to-side anastomosis and end-to-end anastomosis.The main site of central venous intubation was the internal jugular vein.4.Overall,the incidence of complication of AVF was significantly lower than that of catheters.