| Objective:Understand the use of vascular access in maintenance hemodialysis patients in Wuhan;explore the factors affecting the use of vascular access in maintenance hemodialysis patients in Wuhan;analyze the changes in vascular access of maintenance hemodialysis patients in Wuhan in the past 4 years and explore the reasons for these changes;improve the clinical data of vascular access in maintenance hemodialysis patients in Wuhan to provide reference for clinical research.Method:Through literature review,the variables that affect the use of vascular access in maintenance hemodialysis patients were screened,and the items collected in this study were made based on the results of literature review.With the consent of the Wuhan Hemodialysis Quality Control Center,the data of Wuhan hemodialysis patients from January 1,2017 to December 31,2020 were screened in its hemodialysis quality control system,and the maintenance hemodialysis patients meeting the intake and drainage standards were selected as There were 2358 cases in 2017,3030 cases in 2018,3952 cases in 2019,and 5135 cases in 2020.The data was transcribed.The SPSS24.0 software was used for statistical analysis,and the general condition of patients,the use of vascular access and the type of vascular access during the first dialysis were analyzed by descriptive analysis.The analysis of gender,primary disease,independent hemodialysis center and hemodialysis center of general hospitals in the vascular access of patients used chi-square test.The correlation between patient’s vascular access and age,patient’s vascular access and dialysis vintage was analyzed by Spearman’s univariate correlation analysis.Changes in the distribution of vascular access,primary disease and gender of patients were tested by chi-square,the change of average age was analyzed by variance analysis,and changes in average dialysis vintage were tested by non-parametric tests.P<0.05 was considered as statistically significant.Result:1.General information of maintenance hemodialysis patients in Wuhan(1)2017: 2358 cases,including 1414 males(59.97%)and 944 females(40.03%).(2)2018: 3030 cases,including 1825 males(60.23%)and 1205 females(39.77%).(3)2019: 3952 cases,including 2416 males(61.13%)and 1536 females(38.87%).(4)2020: 5135 cases,including 3173 males(61.79%)and 1962 females(38.21%).2.The use of vascular access in maintenance hemodialysis patients in Wuhan from2017 to 2020(1)Usage of different vascular access in maintenance hemodialysis patientsThe main use of autogenous arteriovenous fistulas was 82.36%,80.26%,77.33%,73.481% in 4 years;followed by the use of tunneled cuffed catheter,which were 15.22%,17.39%,19.99%,23.33% in 4 years;other vascular access accounts for a low proportion.(2)Usage of different vascular access in elderly maintenance hemodialysis patientsThe use of autogenous arteriovenous fistulas was 74.98%,73.57%,70.84%,67.39%in 4 years;the use of tunneled cuffed catheter was 22.69%,24.05%,26.48%,29.41% in 4years;other vascular access accounts for a low proportion.(3)Distribution of vascular access for the first dialysis in maintenance hemodialysis patientsNon-cuffed catheter are the main ones,58.02%,53.98%,53.01%,47.36% in 4 years,and the use of autogenous arteriovenous fistula was 28.50%,29.97%,30.39%,36.44%;The use of tunneled cuffed catheter was 11.87%,14.88%,15.59%,and 15.50%.3.Analysis of influencing factors of vascular access in maintenance hemodialysis patients in Wuhan from 2017 to 2020(1)Gender: The usage rate of autologous arteriovenous fistulas in male patients is higher than that in female patients(all p<0.05);the usage rate of tunneled cuffed catheter is lower than that of female patients.(2)Primary disease: Compared with patients with primary glomerular disease and secondary glomerular disease(except in 2017),hypertensive renal damage and non-hypertensive renal damage,diabetic nephropathy and non-diabetic patients,the usage rate of autogenous arteriovenous fistula and tunneled cuffed catheter were significantly different(both p<0.05).(3)Age: The usage rate of autologous arteriovenous fistulas in elderly patients is lower than that of non-elderly patients(all p<0.05);the usage rate of tunneled cuffed catheter in elderly patients is higher than that of non-elderly patients(all p<0.05));The usage rate of autogenous arteriovenous fistula from 2017 to 2020 was negatively correlated with age(both p<0.05).The usage rate of tunneled cuffed catheter was positively correlated with age(both p<0.05).(4)Dialysis vintage: The usage rate of autologous arteriovenous fistulas from 2017 to2020 is positively correlated with the dialysis vintage(all p<0.05);the usage rate of the tunneled cuffed catheter is negatively correlated with the dialysis vintage(all p< 0.05).4.Changes in the use of vascular access in maintenance hemodialysis patients in Wuhan in the past 4 years(1)Changes in the vascular access of maintenance hemodialysis patients in Wuhan:The usage rate of autologous arteriovenous fistulas in patients showed a decreasing trend(p<0.05);the usage rate of tunneled cuffed catheter showed an increasing trend(p<0.05);The usage rate of non-cuffed catheter showed an increasing trend(p<0.05).(2)Changes in factors related to the use of vascular access in maintenance hemodialysis patients in Wuhan(1)Gender: With the change of years,the proportion of male patients is increasing,and the proportion of female patients is decreasing,but the difference is not statistically significant(p>0.05).(2)Primary disease: The proportion of patients with primary glomerular disease is getting lower and lower(p<0.05)with the change of years;the proportion of patients with secondary glomerular disease is getting higher and higher(p<0.05);The proportion of patients with diabetic kidney disease is getting higher and higher(p<0.05);the difference in the proportion of patients with hypertensive kidney damage is not statistically significant(p>0.05).(3)Age: The average age of maintenance hemodialysis patients in Wuhan is increasing year by year(p<0.05).(4)Dialysis vintage: The average dialysis age of maintenance hemodialysis patients in Wuhan has increased year by year(p<0.05).Conclusion:1.The use of vascular access in maintenance hemodialysis patients in Wuhan is not ideal,which is manifested by the low usage rate of autogenous arteriovenous fistulas,the high usage rate of catheters with tunneled cuffed catheter,and the low usage rate of graft internal arteriovenous fistulas.2.The usage rate of autologous arteriovenous fistula for the first dialysis of maintenance hemodialysis patients in Wuhan is low.3.There are differences in the composition of vascular access in patients of different gender,age,dialysis vintage,and primary disease.Male,low age,low dialysis vintage,and primary glomerular disease are positive factors for the use of autogenous arteriovenous fistula.Female,elderly,high dialysis vintage,secondary glomerular disease,diabetic kidney disease,hypertensive kidney damage are the positive factor for the use of tunneled cuffed catheter.It is suggested that medical staff should take corresponding intervention measures for different patients during the follow-up period of chronic kidney disease patients to increase the usage rate of autogenous arteriovenous fistula.4.Changes in the primary disease structure,average age and dialysis vintage of maintenance hemodialysis patients in Wuhan have caused changes in the vascular access composition of maintenance hemodialysis patients.The management of diabetes,hypertension and other diseases should be strengthened as the primary prevention of patients with chronic kidney disease,establish a multidisciplinary cooperative medical team to do a good job in the management of patients’ chronic diseases and the maintenance of vascular access,improve the condition of patients’ vascular access,extend the service life of patients’ vascular access,and improve patient prognosis. |
PDF Full Text Request